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Am J Perinatol 2020; 37(04): 398-408
DOI: 10.1055/s-0039-1679916
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Maternal and Infant Adverse Outcomes Associated with Mild and Severe Preeclampsia during the First Year after Delivery in the United States

Thanh G.N. Ton
1   Precision Health Economics, Oakland, California
,
Mihoko V. Bennett
2   Division of Neonatal and Developmental Medicine, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, California
,
Devin Incerti
1   Precision Health Economics, Oakland, California
,
Desi Peneva
1   Precision Health Economics, Oakland, California
,
Maurice Druzin
3   Division of Maternal-Fetal Medicine, Stanford University School of Medicine, Stanford, California
,
Warren Stevens
4   PAREXEL International, Durham, North Carolina
,
Alexander J. Butwick
5   Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
,
Henry C. Lee
2   Division of Neonatal and Developmental Medicine, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, California
› Author Affiliations Funding All phases of this study were supported by rEVO Biologics Inc. The sponsor was not involved in the design of the study, the review and approval of the report, and the decision to submit the report for publication. The funding agreement ensured the authors' independence in designing the study, interpreting the data, writing, and submitting the report for publication.
Further Information

Publication History

05 July 2018

21 January 2019

Publication Date:
19 February 2019 (online)

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Abstract

Objective The burden of preeclampsia severity on the health of mothers and infants during the first year after delivery is unclear, given the lack of population-based longitudinal studies in the United States.

Study design We assessed maternal and infant adverse outcomes during the first year after delivery using population-based hospital discharge information merged with vital statistics and birth certificates of 2,021,013 linked maternal–infant births in California. We calculated sampling weights using the National Center for Health Statistics data to adjust for observed differences in maternal characteristics between California and the rest of the United States. Separately, we estimated the association between preeclampsia and gestational age and examined collider bias in models of preeclampsia and maternal and infant adverse outcomes.

Results Compared with women without preeclampsia, women with mild and severe preeclampsia delivered 0.66 weeks (95% confidence interval [CI]: 0.64, 0.68) and 2.74 weeks (95% CI: 2.72, 2.77) earlier, respectively. Mild preeclampsia was associated with an increased risk of having any maternal adverse outcome (relative risk [RR] = 1.95; 95% CI: 1.93, 1.97), as was severe preeclampsia (RR = 2.80; 95% CI: 2.78, 2.82). The risk of an infant adverse outcome was increased for severe preeclampsia (RR = 2.15; 95% CI: 2.14, 2.17) but only marginally for mild preeclampsia (RR = 0.99; 95% CI: 0.98, 1). Collider bias produced an inverse association for mild preeclampsia and attenuated the association for severe preeclampsia in models for any infant adverse outcome.

Conclusion Using multiple datasets, we estimated that severe preeclampsia is associated with a higher risk of maternal and infant adverse outcomes compared with mild preeclampsia, including an earlier preterm delivery.

Keywords

maternal morbidity - perinatal morbidity - preeclampsia - severe features

Supplementary Material

 

  • References

  • 1 Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet 2006; 367 (9516): 1066-1074
    CrossrefPubMedGoogle Scholar
  • 2 Kuklina EV, Ayala C, Callaghan WM. Hypertensive disorders and severe obstetric morbidity in the United States. Obstet Gynecol 2009; 113 (06) 1299-1306
    CrossrefPubMedGoogle Scholar
  • 3 Knight M. ; UKOSS. Eclampsia in the United Kingdom 2005. BJOG 2007; 114 (09) 1072-1078
    CrossrefPubMedGoogle Scholar
  • 4 Liu S, Joseph KS, Bartholomew S. , et al. Temporal trends and regional variations in severe maternal morbidity in Canada, 2003 to 2007. J Obstet Gynaecol Can 2010; 32 (09) 847-855
    CrossrefPubMedGoogle Scholar
  • 5 Steegers EA, von Dadelszen P, Duvekot JJ, Pijnenborg R. Pre-eclampsia. Lancet 2010; 376 (9741): 631-644
    CrossrefPubMedGoogle Scholar
  • 6 Hutcheon JA, Lisonkova S, Joseph KS. Epidemiology of pre-eclampsia and the other hypertensive disorders of pregnancy. Best Pract Res Clin Obstet Gynaecol 2011; 25 (04) 391-403
    CrossrefPubMedGoogle Scholar
  • 7 MacKay AP, Berg CJ, Atrash HK. Pregnancy-related mortality from preeclampsia and eclampsia. Obstet Gynecol 2001; 97 (04) 533-538
    PubMedGoogle Scholar
  • 8 Berg CJ, Callaghan WM, Syverson C, Henderson Z. Pregnancy-related mortality in the United States, 1998 to 2005. Obstet Gynecol 2010; 116 (06) 1302-1309
    CrossrefPubMedGoogle Scholar
  • 9 Irgens HU, Reisaeter L, Irgens LM, Lie RT. Long term mortality of mothers and fathers after pre-eclampsia: population based cohort study. BMJ 2001; 323 (7323): 1213-1217
    CrossrefPubMedGoogle Scholar
  • 10 Creanga AA, Berg CJ, Syverson C, Seed K, Bruce FC, Callaghan WM. Pregnancy-related mortality in the United States, 2006-2010. Obstet Gynecol 2015; 125 (01) 5-12
    CrossrefPubMedGoogle Scholar
  • 11 Shih T, Peneva D, Xu X. , et al. The rising burden of preeclampsia in the United States impacts both maternal and child health. Am J Perinatol 2016; 33 (04) 329-338
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Zhang J, Meikle S, Trumble A. Severe maternal morbidity associated with hypertensive disorders in pregnancy in the United States. Hypertens Pregnancy 2003; 22 (02) 203-212
    CrossrefPubMedGoogle Scholar
  • 13 Haddad B, Deis S, Goffinet F, Paniel BJ, Cabrol D, Siba BM. Maternal and perinatal outcomes during expectant management of 239 severe preeclamptic women between 24 and 33 weeks' gestation. Am J Obstet Gynecol 2004; 190 (06) 1590-1595
    CrossrefPubMedGoogle Scholar
  • 14 Ananth CV, Savitz DA, Luther ER, Bowes Jr WA. Preeclampsia and preterm birth subtypes in Nova Scotia, 1986 to 1992. Am J Perinatol 1997; 14 (01) 17-23
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Tuuli MG, Rampersad R, Stamilio D, Macones G, Odibo AO. Perinatal outcomes in women with preeclampsia and superimposed preeclampsia: do they differ?. Am J Obstet Gynecol 2011; 204 (06) 508.e1-508.e7
    CrossrefPubMedGoogle Scholar
  • 16 Kim LH, Cheng YW, Delaney S, Jelin AC, Caughey AB. Is preeclampsia associated with an increased risk of cesarean delivery if labor is induced?. J Matern Fetal Neonatal Med 2010; 23 (05) 383-388
    CrossrefPubMedGoogle Scholar
  • 17 Ray JG, Vermeulen MJ, Schull MJ, Redelmeier DA. Cardiovascular health after maternal placental syndromes (CHAMPS): population-based retrospective cohort study. Lancet 2005; 366 (9499): 1797-1803
    CrossrefPubMedGoogle Scholar
  • 18 Brown MC, Best KE, Pearce MS, Waugh J, Robson SC, Bell R. Cardiovascular disease risk in women with pre-eclampsia: systematic review and meta-analysis. Eur J Epidemiol 2013; 28 (01) 1-19
    PubMedGoogle Scholar
  • 19 Bellamy L, Casas J-P, Hingorani AD, Williams DJ. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ 2007; 335 (7627): 974
    CrossrefPubMedGoogle Scholar
  • 20 Lykke JA, Langhoff-Roos J, Sibai BM, Funai EF, Triche EW, Paidas MJ. Hypertensive pregnancy disorders and subsequent cardiovascular morbidity and type 2 diabetes mellitus in the mother. Hypertension 2009; 53 (06) 944-951
    CrossrefPubMedGoogle Scholar
  • 21 Vikse BE, Irgens LM, Leivestad T, Skjaerven R, Iversen BM. Preeclampsia and the risk of end-stage renal disease. N Engl J Med 2008; 359 (08) 800-809
    CrossrefPubMedGoogle Scholar
  • 22 Wang I-K, Muo C-H, Chang Y-C. , et al. Association between hypertensive disorders during pregnancy and end-stage renal disease: a population-based study. CMAJ 2013; 185 (03) 207-213
    CrossrefPubMedGoogle Scholar
  • 23 Basso O, Rasmussen S, Weinberg CR, Wilcox AJ, Irgens LM, Skjaerven R. Trends in fetal and infant survival following preeclampsia. JAMA 2006; 296 (11) 1357-1362
    CrossrefPubMedGoogle Scholar
  • 24 Stoll BJ, Hansen NI, Bell EF. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics 2010; 126 (03) 443-456
    CrossrefPubMedGoogle Scholar
  • 25 Costeloe KL, Hennessy EM, Haider S, Stacey F, Marlow N, Draper ES. Short term outcomes after extreme preterm birth in England: comparison of two birth cohorts in 1995 and 2006 (the EPICure studies). BMJ 2012; 345: e7976
    CrossrefPubMedGoogle Scholar
  • 26 Jelin AC, Kaimal AJ, Kuzniewicz M, Little SE, Cheng YW, Caughey AB. Preterm preeclampsia: 32 to 37 weeks gestation. J Matern Fetal Neonatal Med 2012; 25 (11) 2198-2201
    CrossrefPubMedGoogle Scholar
  • 27 Kajantie E, Eriksson JG, Osmond C, Thornburg K, Barker DJ. Pre-eclampsia is associated with increased risk of stroke in the adult offspring: the Helsinki birth cohort study. Stroke 2009; 40 (04) 1176-1180
    CrossrefPubMedGoogle Scholar
  • 28 Wu CS, Nohr EA, Bech BH, Vestergaard M, Catov JM, Olsen J. Health of children born to mothers who had preeclampsia: a population-based cohort study. Am J Obstet Gynecol 2009; 201 (03) 269.e1-269.e10
    CrossrefPubMedGoogle Scholar
  • 29 Ferreira I, Peeters LL, Stehouwer CD. Preeclampsia and increased blood pressure in the offspring: meta-analysis and critical review of the evidence. J Hypertens 2009; 27 (10) 1955-1959
    CrossrefPubMedGoogle Scholar
  • 30 Vestergaard M, Basso O, Henriksen TB, Østergaard J, Secher NJ, Olsen J. Pre-eclampsia and febrile convulsions. Arch Dis Child 2003; 88 (08) 726-727
    CrossrefPubMedGoogle Scholar
  • 31 Wu CS, Sun Y, Vestergaard M. , et al. Preeclampsia and risk for epilepsy in offspring. Pediatrics 2008; 122 (05) 1072-1078
    CrossrefPubMedGoogle Scholar
  • 32 Mann JR, McDermott S, Bao H, Hardin J, Gregg A. Pre-eclampsia, birth weight, and autism spectrum disorders. J Autism Dev Disord 2010; 40 (05) 548-554
    CrossrefPubMedGoogle Scholar
  • 33 Walker CK, Krakowiak P, Baker A, Hansen RL, Ozonoff S, Hertz-Picciotto I. Preeclampsia, placental insufficiency, and autism spectrum disorder or developmental delay. JAMA Pediatr 2015; 169 (02) 154-162
    CrossrefPubMedGoogle Scholar
  • 34 Cheng YJ, Imperatore G, Geiss LS. , et al. Secular changes in the age-specific prevalence of diabetes among U.S. adults: 1988-2010. Diabetes Care 2013; 36 (09) 2690-2696
    CrossrefPubMedGoogle Scholar
  • 35 Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA 2012; 307 (05) 491-497
    CrossrefPubMedGoogle Scholar
  • 36 Ananth CV, Keyes KM, Wapner RJ. Pre-eclampsia rates in the United States, 1980-2010: age-period-cohort analysis. BMJ 2013; 347: f6564
    CrossrefPubMedGoogle Scholar
  • 37 Buchbinder A, Sibai BM, Caritis S. , et al; National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Adverse perinatal outcomes are significantly higher in severe gestational hypertension than in mild preeclampsia. Am J Obstet Gynecol 2002; 186 (01) 66-71
    CrossrefPubMedGoogle Scholar
  • 38 Odegård RA, Vatten LJ, Nilsen ST, Salvesen KÅ, Austgulen R. Preeclampsia and fetal growth. Obstet Gynecol 2000; 96 (06) 950-955
    PubMedGoogle Scholar
  • 39 Simpson LL. Maternal medical disease: risk of antepartum fetal death. Semin Perinatol 2002; 26 (01) 42-50
    CrossrefPubMedGoogle Scholar
  • 40 Stevens W, Shih T, Incerti D. , et al. Short-term costs of preeclampsia to the United States health care system. Am J Obstet Gynecol 2017; 217 (03) 237-248
    CrossrefPubMedGoogle Scholar
  • 41 Wilcox AJ, Weinberg CR, Basso O. On the pitfalls of adjusting for gestational age at birth. Am J Epidemiol 2011; 174 (09) 1062-1068
    CrossrefPubMedGoogle Scholar
  • 42 Hetzel AM. U.S. Vital Statistics System. National Center for Health Statistics. 1997 . Available at: http://www.cdc.gov/nchs/data/misc/usvss.pdf . Accessed November 3, 2018
    PubMed
  • 43 Mauldin JG, Newman RB. Preterm birth risk assessment. Semin Perinatol 2001; 25 (04) 215-222
    CrossrefPubMedGoogle Scholar
  • 44 Kramer MS, Zhang X, Platt RW. Analyzing risks of adverse pregnancy outcomes. Am J Epidemiol 2014; 179 (03) 361-367
    CrossrefPubMedGoogle Scholar
  • 45 Hernández-Díaz S, Schisterman EF, Hernán MA. The birth weight “paradox” uncovered?. Am J Epidemiol 2006; 164 (11) 1115-1120
    CrossrefPubMedGoogle Scholar
  • 46 Wilcox AJ. On the importance--and the unimportance--of birthweight. Int J Epidemiol 2001; 30 (06) 1233-1241
    CrossrefPubMedGoogle Scholar
  • 47 VanderWeele TJ, Hernández-Diaz S. Is there a direct effect of pre-eclampsia on cerebral palsy not through preterm birth?. Paediatr Perinat Epidemiol 2011; 25 (02) 111-115
    CrossrefPubMedGoogle Scholar
  • 48 Spiegelman D, Hertzmark E. Easy SAS calculations for risk or prevalence ratios and differences. Am J Epidemiol 2005; 162 (03) 199-200
    CrossrefPubMedGoogle Scholar
  • 49 Skinner S, Li R, Hertzmark E, Spiegelman D. The SAS RELRISK9 Macro. 2012
    PubMed
  • 50 VanderWeele TJ, Ding P. Sensitivity analysis in observational research: introducing the E-value. Ann Intern Med 2017; 167 (04) 268-274
    CrossrefPubMedGoogle Scholar
  • 51 Al-Jameil N, Aziz Khan F, Fareed Khan M, Tabassum H. A brief overview of preeclampsia. J Clin Med Res 2014; 6 (01) 1-7
    CrossrefPubMedGoogle Scholar
  • 52 Spargo BH, Lichtig C, Luger AM, Katz AI, Lindheimer MD. The renal lesion in preeclampsia. Perspect Nephrol Hypertens 1976; 5: 129-137
    PubMedGoogle Scholar
  • 53 Geller SE, Ahmed S, Brown ML, Cox SM, Rosenberg D, Kilpatrick SJ. International Classification of Diseases-9th revision coding for preeclampsia: how accurate is it?. Am J Obstet Gynecol 2004; 190 (06) 1629-1633
    CrossrefPubMedGoogle Scholar
  • 54 Ferver K, Burton B, Jesilow P. The use of claims data in healthcare research. Open Public Health J 2009; 2: 11-24
    CrossrefPubMedGoogle Scholar
  • 55 Friedman SA, Schiff E, Kao L, Sibai BM. Neonatal outcome after preterm delivery for preeclampsia. Am J Obstet Gynecol 1995; 172 (06) 1785-1788
    CrossrefPubMedGoogle Scholar
  • 56 O'Shea JE, Davis PG, Doyle LW. ; Victorian Infant Collaborative Study Group. Maternal preeclampsia and risk of bronchopulmonary dysplasia in preterm infants. Pediatr Res 2012; 71 (02) 210-214
    CrossrefPubMedGoogle Scholar
  • 57 Masoura S, Kalogiannidis I, Margioula-Siarkou C. , et al. Neonatal outcomes of late preterm deliveries with pre-eclampsia. Minerva Ginecol 2012; 64 (02) 109-115
    PubMedGoogle Scholar
  • 58 Liu S, Basso O, Kramer MS. Association between unintentional injury during pregnancy and excess risk of preterm birth and its neonatal sequelae. Am J Epidemiol 2015; 182 (09) 750-758
    CrossrefPubMedGoogle Scholar
  • 59 Mann JR, McDermott S, Griffith MI, Hardin J, Gregg A. Uncovering the complex relationship between pre-eclampsia, preterm birth and cerebral palsy. Paediatr Perinat Epidemiol 2011; 25 (02) 100-110
    CrossrefPubMedGoogle Scholar
  • 60 Centers for Disease Control and Prevention (CDC) National Center for Chronic Disease Prevention and Health Promotion. Safe Motherhood: Advancing the Health of Mothers in the 21st Century. 2016 . Available at: https://www.cdc.gov/chronicdisease/resources/publications/aag/pdf/2016/aag-maternal-health.pdf . Accessed November 3, 2018
    PubMed
  • 61 United States Department of Health and Human Services, Centers of Disease Control and Prevention, National Center for Health Statistics, Division of Vital Statistics. Linked Birth/Infant Death Records 2007–2013. Available at: http://wonder.cdc.gov/lbd-current.html . Accessed November 3, 2018
    PubMed
  • 62 Lain SJ, Hadfield RM, Raynes-Greenow CH. , et al. Quality of data in perinatal population health databases: a systematic review. Med Care 2012; 50 (04) e7-e20
    CrossrefPubMedGoogle Scholar