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Prediction and Prevention of Recurrent Preeclampsia

Barton, John R. MD; Sibai, Baha M. MD

doi: 10.1097/AOG.0b013e3181801d56
Clinical Expert Series

Women with a history of previous preeclampsia are at increased risk of preeclampsia and other adverse pregnancy outcomes in subsequent pregnancies. The magnitude of this risk is dependent on gestational age at time of disease onset, severity of disease, and presence or absence of preexisting medical disorders. The objective in the management of these patients is to reduce risk factors by optimizing maternal health before conception and to detect obstetric complications as early as possible. This objective can be achieved by formulating a rational approach that includes preconception evaluation and counseling, early antenatal care, frequent monitoring of maternal and fetal well-being, and timely delivery. First-trimester ultrasound examination is essential for accurate dating and establishing fetal number. Laboratory studies are obtained to assess the function of different organ systems that are likely to be affected by preeclampsia and to establish a baseline for future assessment. Recent studies have confirmed that there is no single biomarker that can be clinically useful for the prediction of recurrent preeclampsia. Combinations of biomarkers and biophysical parameters appear promising, but more data are needed to confirm their use in clinical practice. Supplementation with fish oil, calcium, or vitamin C and E and the use of antihypertensives have been shown to be ineffective in the prevention of recurrent preeclampsia and are not recommended. Supplementation with low-dose aspirin may be offered on an individualized basis. Because women with previous preeclampsia are at increased risk for adverse pregnancy outcomes (preterm delivery, fetal growth restriction, abruptio placentae, and fetal death) in subsequent pregnancies, we recommend more frequent monitoring for signs and symptoms of severe hypertension or preeclampsia than that recommended for normal pregnancy. This monitoring may include more frequent prenatal visits, home blood pressure monitoring, or nursing contacts. For patients with a prior pregnancy complicated by preeclampsia with fetal growth restriction, we recommend serial ultrasound evaluation of fetal growth and amniotic fluid volume. The development of severe gestational hypertension, fetal growth restriction, or recurrent preeclampsia requires maternal hospitalization.

Women with previous preeclampsia are at increased risk for recurrence in subsequent pregnancies, but currently there are no clinically useful methods to predict or prevent preeclampsia recurrence. Supplemental Digital Content is Available in the Text.

From the 1Division of Maternal–Fetal Medicine, Central Baptist Hospital, Lexington, Kentucky; and the 2Divison of Maternal–Fetal Medicine, University of Cincinnati, Cincinnati, Ohio.

Continuing medical education is available online at www.greenjournal.org

Corresponding author: John R. Barton, MD, Perinatal Diagnostic Center, 1740 Nicholasville Road, Lexington, KY 40503; e-mail: jbarton@bhsi.com.

Financial Disclosure Dr. Barton is involved in investigating the potential use of biochemical markers to predict preeclampsia for Beckman Coulter, Inc. (Fullerton, CA). Dr. Sibai acts as a consultant to Beckman Coulter, Inc., and Ortho Clinical Diagnostics, Inc. (Rochester, NY), regarding the potential use of biochemical markers to predict preeclampsia.

© 2008 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.