Risk Factors for Early- and Late-Onset Superimposed Preeclampsia

Kazuma Onishi; Elizabeth Seagraves; Dana Baraki; Thomas Donaldson; Carole Barake; Alfred Abuhamad; Jim C Huang; Tetsuya Kawakita

doi:10.1055/a-2096-5052

Risk Factors for Early- and Late-Onset Superimposed Preeclampsia

Am J Perinatol. 2023 Jun 19. doi: 10.1055/a-2096-5052. Online ahead of print.

Authors

Kazuma Onishi¹, Elizabeth Seagraves², Dana Baraki³, Thomas Donaldson⁴, Carole Barake⁵, Alfred Abuhamad¹, Jim C Huang⁶, Tetsuya Kawakita¹

Affiliations

¹ Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia.
² Department of Maternal Fetal Medicine, Beaumont Maternal-Fetal Medicine, Beverly Hills, Michigan.
³ Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio.
⁴ Department of Obstetrics and Gynecology, Temple University, Philadelphia, Pennsylvania.
⁵ Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas.
⁶ Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan.

PMID: 37211009
DOI: 10.1055/a-2096-5052

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..