Obstet Gynecol Sci.  2020 Apr;63(3):270-277. 10.5468/ogs.2020.63.3.270.

A study to compare maternal and perinatal outcome in early vs. late onset preeclampsia

• Wadhwani P
• Saha PK
• Kalra JK
• Gainder S
• Sundaram V

• KMID: 2500416
• DOI: http://doi.org/10.5468/ogs.2020.63.3.270

Abstract

Objective
The risk factors, clinical trends, and maternal and fetal health of early- and late-onset preeclampsia have not been adequately studied. We examined the effects of early- and late-onset preeclampsia on maternal and perinatal outcomes as well as the known risk factors of preeclampsia.
Methods
One hundred and fifty women with preeclampsia were consecutively enrolled in each group. Those who developed preeclampsia before 34 weeks of gestation were identified as having early-onset preeclampsia, while those who developed at 34 weeks or later were identified as having late-onset preeclampsia. Maternal and perinatal outcomes were compared between groups.
Results
Compared with the late-onset group, the early-onset group had higher rates of abruptio placentae (16% vs. 7.3%; P=0.019), but there was no intergroup difference in the composite maternal outcomes. A significantly higher number of women with early-onset preeclampsia developed severe features during the disease course, and most required treatment with antihypertensive drugs. Late-onset preeclampsia was more prevalent among primigravid mothers. Babies born to mothers with early-onset preeclampsia had a significantly higher rate of adverse outcomes.
Conclusion
These study findings indicate that women with early-onset preeclampsia had more adverse outcome than those with late-onset preeclampsia, but the difference was not statistically significant. There were more babies with adverse perinatal outcomes in the early-than late-onset group.

Keyword

Early-onset preeclampsia; Late onset preeclampsia; Maternal outcome; Perinatal outcome

Figure

• 

  Fig. 1 Consort flow chart showing sample size selection.PE, preeclampsia; POG, period of gestation; EO-PE, early-onset preeclampsia; LO-PE, late-onset preeclampsia.

Reference

1. American College of Obstetricians and Gynecologists. Task Force on Hypertension in Pregnancy. American College of Obstetricians and Gynecologists and others. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists' task force on hypertension in pregnancy. Obstet Gynecol. 2013; 122:1122–1131. PMID: 24150027.

2. Duckitt K, Harrington D. Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. BMJ. 2005; 330:565. PMID: 15743856.

3. Basso O, Rasmussen S, Weinberg CR, Wilcox AJ, Irgens LM, Skjaerven R. Trends in fetal and infant survival following preeclampsia. JAMA. 2006; 296:1357–1362. PMID: 16985227.

4. Badawi N, Kurinczuk JJ, Keogh JM, Alessandri LM, O'Sullivan F, Burton PR, et al. Antepartum risk factors for newborn encephalopathy: the Western Australian case-control study. BMJ. 1998; 317:1549–1553. PMID: 9836652.

5. Friedman SA, Schiff E, Kao L, Sibai BM. Neonatal outcome after preterm delivery for preeclampsia. Am J Obstet Gynecol. 1995; 172:1785–1792. PMID: 7778633.

6. Vestergaard M, Basso O, Henriksen TB, Østergaard J, Secher NJ, Olsen J. Pre-eclampsia and febrile convulsions. Arch Dis Child. 2003; 88:726–727. PMID: 12876175.

7. Ness RB, Roberts JM. Heterogeneous causes constituting the single syndrome of preeclampsia: a hypothesis and its implications. Am J Obstet Gynecol. 1996; 175:1365–1370. PMID: 8942516.

8. von Dadelszen P, Magee LA, Roberts JM. Subclassification of preeclampsia. Hypertens Pregnancy. 2003; 22:143–148. PMID: 12908998.

9. Roberts CL, Ford JB, Algert CS, Antonsen S, Chalmers J, Cnattingius S, et al. Population-based trends in pregnancy hypertension and pre-eclampsia: an international comparative study. BMJ Open. 2011; 1:e000101.

10. Turner JA. Diagnosis and management of pre-eclampsia: an update. Int J Womens Health. 2010; 2:327–337. PMID: 21151680.

11. Summary of recommendation statements. Kidney Int Suppl (2011). 2012; 2:8–12. PMID: 25018916.

12. Lubchenco LO, Hansman C, Boyd E. Intrauterine growth in length and head circumference as estimated from live births at gestational ages from 26 to 42 weeks. Pediatrics. 1966; 37:403–408. PMID: 5906365.

13. Valensise H, Vasapollo B, Gadgliardi G, Noveli GP. Early and late preeclampsia: two different hemodynamic state in the latent phase of the disease. Hypertension. 2008; 52:873–880. PMID: 18824660.

14. LaMarca BD, Gilbert J, Granger JP. Recent progress toward the understanding of the pathophysiology of hypertension during preeclampsia. Hypertension. 2008; 51:982–988. PMID: 18259004.

15. Brosens IA, Robertson WB, Dixon HG. The role of the spiral arteries in the pathogenesis of preeclampsia. Obstet Gynecol Annu. 1972; 1:177–191. PMID: 4669123.

16. Stubert J, Ullmann S, Dieterich M, Diedrich D, Reimer T. Clinical differences between early- and late-onset severe preeclampsia and analysis of predictors for perinatal outcome. J Perinat Med. 2014; 42:617–627. PMID: 24778345.

17. Li XL, Guo PL, Xue Y, Gou WL, Tong M, Chen Q. An analysis of the differences between early and late preeclampsia with severe hypertension. Pregnancy Hypertens. 2016; 6:47–52. PMID: 26955772.

18. Lisonkova S, Sabr Y, Mayer C, Young C, Skoll A, Joseph KS. Maternal morbidity associated with early-onset and late-onset preeclampsia. Obstet Gynecol. 2014; 124:771–781. PMID: 25198279.

19. Pettit F, Mangos G, Davis G, Henry A, Brown MA. Pre-eclampsia causes adverse maternal outcomes across the gestational spectrum. Pregnancy Hypertens. 2015; 5:198–204. PMID: 25943645.

20. Madazli R, Yuksel MA, Imamoglu M, Tuten A, Oncul M, Aydin B, et al. Comparison of clinical and perinatal outcomes in early- and late-onset preeclampsia. Arch Gynecol Obstet. 2014; 290:53–57. PMID: 24549271.

21. Lisonkova S, Joseph KS. Incidence of preeclampsia: risk factors and outcomes associated with early- versus late-onset disease. Am J Obstet Gynecol. 2013; 209:544.e1–544.12. PMID: 23973398.