Abstract

Background: Hypertensive disorder of pregnancy (HDP) entails a risk of recurrence in a subsequent pregnancy. Several risk factors have been associated with recurrence of hypertensive disorder in pregnancy. There is also evidence that the different clinical forms of HDP may be related to each other. Therefore, in HDP studies, it may be preferable to include all clinical forms of the hypertensive disorder not only in the 1st pregnancy, but also in later pregnancies. Aim: To study recurrence of Hypertensive Disorder of Pregnancy in 2nd Pregnancy with regard to the type and time of onset of hypertensive disorder in 1st pregnancy. Methodology: The study was conducted at department of obstetrics & gynecology Lalla Ded Hospital GMC Srinagar. 250 patients with history and maternity records of hypertensive disorder of pregnancy (HDP) in first pregnancy were followed on OPD basis till final outcome of second pregnancy to observe the recurrence of hypertensive disorder in second pregnancy with regard to type of hypertensive disorder and time of onset of hypertensive disorder in first pregnancy. Paired t-test & Chi-square test was used. Recurrence rate of HDP was reported as percentage along with its 95% confidence interval. Two sided p-values were reported and a p-value of <0.05 was considered statistically significant. Results: Out of 250 patients, 142 (56.8%) had gestational hypertension in 1st pregnancy with recurrence of different types of HDP of 101(71.12%) in present pregnancy. 43(17.2%) patients having preeclampsia/eclampsia in 1st pregnancy had recurrence of 25(58.13%) in present pregnancy. 55(22%) patients having Chronic hypertension in 1st pregnancy had recurrence of 49(89.09%) in present pregnancy.7(2.8%) patients diagnosed as having superimposed preeclampsia in 1st pregnancy had recurrence of 6(85.7%). Out of 3(1.2%) patients diagnosed as having HELLP syndrome in 1st pregnancy, the recurrence was 3(100%). Women who had HDP in their 1st pregnancy had a high risk of repeated HDP in the 2nd pregnancy, but not necessarily the same type. This risk was higher if the onset of hypertension in the 1st pregnancy was early (<34 weeks) of gestation and was associated independently with higher age of pregnant women (> 30 years), women belonging to urban areas and family history of HDP. Conclusion: Women who had HDP in their 1st pregnancy had a high risk of repeated HDP in the 2nd pregnancy, but not necessarily the same type. This risk was higher if the onset of hypertension in the 1st pregnancy was early (<34 weeks) of gestation and was associated independently with higher age of pregnant women (> 30 years), women belonging to urban areas, women with family history of HDP and also associated with higher cases of preterm and caesarean section deliveries.

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• 75.   Langenveld J, Ravelli ACJ, van Kaam AH, van der Ham DP, van Pampus MG, Porath M, et al. Neonatal outcome of pregnancies complicated by hypertensive disorders between 34 and 37 weeks of gestation: a 7 year retrospective analysis of a national registry. Am J OG. 2011;205(6):540.e1-7.
• 76.   Habli M, Levine RJ, Qian C, Sibai B. Neonatal outcomes in pregnancies with preeclampsia or gestational hypertension and in normotensive pregnancies that delivered at 35, 36, or 37 weeks of gestation. Am J OG. 2007;197(4):406.e1-7.
• 77.   Bakker R, Steegers EAP, Hofman A, Jaddoe VWV. Blood Pressure in Different Gestational Trimesters, Fetal Growth, and the Risk of Adverse Birth Outcomes: The Generation R Study. A J Epid. 2011;174(7):797-806.
• 78.   Vreeburg SA, Jacobs DJ, Dekker GA, Heard AR, Priest KR, Chan A. Hypertension during pregnancy in South Australia, part 2: risk factors for adverse maternal and/or perinatal outcome - results of multivariable analysis. ANZJOG. 2004;44(5):410-8.
• 79.   Ferrer RL, Sibai BM, Mulrow CD, Chiquette E, Stevens KR, Cornell J. Management of mild chronic hypertension during pregnancy: a review. Obstetrics and Gynecology. 2000;96(5 Pt 2):849- 60.
• 80.   McCowan LM, Buist RG, North RA, Gamble G. Perinatal morbidity in chronic hypertension. BJOG: An International Journal of Obstetrics & Gynaecology. 1996;103(2):123-9.
• 81.   Churchill D, Duley L, Thornton JG, Jones L. Interventionist versus expectant care for severe pre-eclampsia between 24 and 34 weeks' gestation. Cochrane Database of Systematic Reviews. 2013;7(CD003106).
• 82.   Hutcheon JA, Lisonkova S, Joseph KS. Epidemiology of pre-eclampsia and the other hypertensive disorders of pregnancy. Best Practice & Research in Clinical Obstetrics & Gynaecology. 2011;25(4):391-403.
• 83.   Roberts CL, Algert CS, Morris JM, Ford JB, Henderson-Smart DJ. Hypertensive disorders in pregnancy: a population-based study. Medical Journal of Australia. 2005;182(7):332-5.
• 84.   Ahmad AS, Samuelsen SO. Hypertensive disorders in pregnancy and fetal death at different gestational lengths: a population study of 2 121 371 pregnancies. BJOG: An International Journal of Obstetrics & Gynaecology. 2012;119(12):1521-8.
• 85.   Neilson J. Preeclampsia and eclampsia. The Confidential Enquiry into Maternal and Child Health (CEMACH) Saving mothers lives: Reviewing maternal deaths to make motherhood safer 2003- 2005 London:

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