Risk markers in first pregnancy predict adverse outcomes in second pregnancy
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Key takeaways:
- Forty percent of women with adverse pregnancy outcomes in their first pregnancy had them in their second.
- Elevated risk for adverse outcomes in a second pregnancy varied by race/ethnicity.
Multiple risk markers during a first pregnancy were associated with an adverse pregnancy outcome for a second pregnancy, according to analysis results presented at The Pregnancy Meeting.
“Having a complication in a first pregnancy, such as preterm birth, gestational diabetes, preeclampsia or a stillbirth, is associated with difference in individuals’ subsequent reproductive course,” William A. Grobman, MD, MBA, professor of obstetrics and gynecology and vice chair of clinical operations in obstetrics and gynecology at Ohio State University, told Healio. “Even though people who have had an adverse pregnancy outcome in a first pregnancy are much more likely to have one in a second pregnancy, it is still the case that approximately 40% of adverse pregnancy outcomes in a second pregnancy are among people who didn’t have one in their first pregnancy.”
Grobman and colleagues analyzed data from the nuMoM2b Heart Health Study, a cohort study of nulliparous pregnant women who were followed from the first trimester of their first pregnancy through up to 7 years after delivery. Researchers evaluated data from 2,830 of the women during the period of study who had two pregnancies that continued to at least 20 weeks gestation. Potential risk markers the researchers examined included demographics and clinical measures and laboratory values from the first trimester of the first pregnancy. Researchers defined adverse pregnancy outcomes as hypertensive disorders of pregnancy, preterm birth, small for gestational age, fetal demise or gestational diabetes.
Mean time between pregnancies was 2.9 years. Overall, 31% of women in the analysis had an adverse pregnancy outcome in their first pregnancy. Of these women, 40% also had an adverse pregnancy outcome in their second pregnancy. Of women without an adverse pregnancy outcome in their first pregnancy, 15% developed an adverse pregnancy outcome in their second pregnancy.
Multiple risk markers, such as BMI, blood pressure and cardiometabolic serum analytes, from the first trimester in a first pregnancy were associated with developing an adverse pregnancy outcome in a second pregnancy. There were also notable racial and ethnic disparities, with the risk for adverse pregnancy outcomes across both pregnancies highest for individuals who self-identified as non-Hispanic Black, according to Grobman.
“Clinicians should understand that individuals who have had an adverse pregnancy outcome have a variety of other risks going forward, and ... they need to follow them accordingly,” Grobman said. “It is very much needed to further understand the factors and mechanisms that underlie these conditions that affect people in pregnancy and to develop prevention efforts.”
For more information:
William A. Grobman, MD, MBA, can be reached at william.grobman@osumc.edu.