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Am J Perinatol
DOI: 10.1055/a-2096-5052
Original Article

Risk Factors for Early- and Late-Onset Superimposed Preeclampsia

Kazuma Onishi 
1   Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
,
Elizabeth Seagraves
2   Department of Maternal Fetal Medicine, Beaumont Maternal-Fetal Medicine, Beverly Hills, Michigan
,
Dana Baraki
3   Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio
,
Thomas Donaldson
4   Department of Obstetrics and Gynecology, Temple University, Philadelphia, Pennsylvania
,
Carole Barake
5   Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
,
Alfred Abuhamad
1   Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
,
Jim C. Huang
6   Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan
,
Tetsuya Kawakita
1   Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
› Author Affiliations Funding None.
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Abstract

Objective Risk factors of early- and late-onset preeclampsia among pregnant individuals with chronic hypertension are not well described in the literature. We hypothesized that early- and late-onset superimposed preeclampsia (SIPE) have different risk factors. Therefore, we aimed to examine the risk factors of early- and late-onset SIPE among individuals with chronic hypertension.

Study Design This was a retrospective case-control study of pregnant individuals with chronic hypertension who delivered at 22 weeks' gestation or greater at an academic institution. Early-onset SIPE was defined as SIPE diagnosed before 34 weeks' gestation. To identify risk factors, we compared individuals' characteristics between individuals who developed early- and late-onset SIPE and those who did not. We then compared characteristics between individuals who developed early-onset SIPE and late-onset SIPE. Characteristics with p-values of less than 0.05 by bivariable variables were analyzed by simple and multivariable logistic regression models to calculate crude and adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). Missing values were imputed with multiple imputation.

Results Of 839 individuals, 156 (18.6%) had early-onset, 154 (18.4%) had late-onset SIPE and 529 (63.1%) did not have SIPE. The multivariate logistic regression model showed that serum creatinine ≥ 0.7 mg/dL compared to less than 0.7 mg/dL (aOR: 2.89 [95% CI: 1.63–5.13]), increase of creatinine (1.33 [1.16–1.53]), nulliparity compared to multiparity (1.77 [1.21–2.60]), and pregestational diabetes (1.70 [1.11–2.62]) were risk factors for early-onset SIPE. The multivariate logistic regression model showed that nulliparity compared to multiparity (1.53 [1.05–2.22]) and pregestational diabetes (1.74 [1.14–2.64]) was a risk factor for late-onset SIPE. Serum creatinine ≥ 0.7 mg/dL (2.90 [1.36–6.15]) and increase of creatinine (1.33 [1.10–1.60]) were significantly associated with early-onset SIPE compared to late-onset SIPE.

Conclusion Kidney dysfunction seemed to be associated with the pathophysiology of early-onset SIPE. Nulliparity and pregestational diabetes were common risk factors for both early- and late-onset SIPE.

Key Points

  • Serum creatinine level was positively associated with early-onset superimposed preeclampsia (SIPE).

  • Pregestational diabetes and nulliparity were associated with both early- and late-onset SIPE.

  • The identification of risk factors may provide an opportunity to decrease the rates of SIPE.

Keywords

chronic hypertension - creatinine - nulliparous - pregestational diabetes - pregnancy

Supplementary Material



Publication History

Received: 10 November 2022

Accepted: 19 May 2023

Accepted Manuscript online:
21 May 2023

Article published online:
19 June 2023

© 2023. Thieme. All rights reserved.

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