Pre-eclampsia in the first pregnancy and subsequent risk of stillbirth in black and white gravidas

Mbah, Alfred K.; Alio, Amina P.; Marty, Phillip J.; Bruder, Karen; Whiteman, Valerie E.; Salihu, Hamisu M.

doi:10.1016/j.ejogrb.2009.12.035

« Previous Next »European Journal of Obstetrics & Gynecology and Reproductive Biology
Volume 149, Issue 2 , Pages 165-169, April 2010

Pre-eclampsia in the first pregnancy and subsequent risk of stillbirth in black and white gravidas

Alfred K. Mbah
- Center for Research and Evaluation, The Chiles Center, University of South Florida, Tampa, FL 33612, United States
- Department of Community and Family Health, University of South Florida, Tampa, FL 33612, United States
Amina P. Alio
- Department of Community and Family Health, University of South Florida, Tampa, FL 33612, United States
Phillip J. Marty
- Center for Research and Evaluation, The Chiles Center, University of South Florida, Tampa, FL 33612, United States
Karen Bruder
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of South Florida, Tampa, FL 33612, United States
Valerie E. Whiteman
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of South Florida, Tampa, FL 33612, United States
Hamisu M. Salihu
- Center for Research and Evaluation, The Chiles Center, University of South Florida, Tampa, FL 33612, United States
- Department of Epidemiology and Biostatistics, University of South Florida, Tampa, FL 33612, United States
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of South Florida, Tampa, FL 33612, United States
- Corresponding author at: Center for Research and Evaluation, Lawton and Rhea Chiles Center for Healthy Mothers and Babies, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL 33613, United States. Tel.: +1 813 974 1073; fax: +1 813 974 8889.

Received 3 November 2009; received in revised form 21 December 2009; accepted 23 December 2009. published online 11 January 2010.

Abstract

Objective

To examine the association between prior pre-eclampsia and subsequent stillbirth in black women and white women.

Study design

This is a population-based retrospective study of Missouri maternally linked birth cohort files from 1989 to 2005. We analyzed singleton first and second births to mothers in the state of Missouri. The study population comprised women who experienced pre-eclampsia in their first pregnancy and a comparison group consisting of women who did not. The two groups were followed to their second pregnancy to document stillbirth occurrence. Adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association between prior pre-eclampsia and subsequent stillbirth were obtained from logistic regression models.

Results

Women who experienced prior pre-eclampsia had a 43% increased risk of subsequent stillbirth [OR=1.43; 95% CI=1.08–1.89]. Whereas women with a history of late-onset pre-eclampsia had no elevated risk for subsequent stillbirth, those whose first pregnancy resulted in early-onset pre-eclampsia had a more than 4-fold increased risk of stillbirth in their second pregnancy [OR=4.07; 95% CI=2.32–7.14]. When sub-analysis was performed on the two main racial groups in the State, we found that elevated risk for subsequent stillbirth in a second pregnancy was observed among black women with prior early-onset pre-eclampsia (OR=8.21; 95% CI=4.03–16.70) but not in whites (OR=1.95; 95% CI=0.72–5.26).

Conclusion

Initiation of pregnancy with pre-eclampsia elevates the risk for subsequent stillbirth. The risk elevation is most pronounced in black women with early-onset pre-eclampsia in their first pregnancy. This information is valuable for inter-pregnancy counseling of affected women.

Keywords: Prior pre-eclampsia, Stillbirth, Late-onset pre-eclampsia, Early-onset pre-eclampsia, Missouri database, Inter-pregnancy counseling