Active Management Reduces the Incidence of Recurrent Pre-eclampsia and Improves Maternal and Fetal Outcomes in Women With Recurrent Pre-eclampsia

Background: Women with previous pre-eclampsia are at an increased risk of developing recurrent pre-eclampsia. Intervention with low dose aspirin had been recommended to reduce the incidence of recurrent pre-eclampsia. However, the association between interventions and maternal and neonatal outcomes in subsequent pregnancies in women with previous pre-eclampsia has not been fully studied. Methods: In this prospective study, a total of 41 patients with previous pre-eclampsia received low dose aspirin and active management (including psychological and physiological intervention), between 10 to 28 weeks until 32 to 34 weeks in our regional referral hospital. The recurrence of pre-eclampsia, and maternal and neonatal outcomes in this pregnancy were analyzed and compared to our previous study which reported a 60% recurrence of pre-eclampsia in our regional referral hospital. Results: Thirteen women with previous pre-eclampsia developed recurrent pre-eclampsia. The time of onset or severity of pre-eclampsia in the previous pregnancy was not associated with the incidence of recurrent pre-eclampsia. The time of onset of previous pre-eclampsia was also not associated with the time of onset in subsequent pre-eclampsia. However, the number of severe recurrent pre-eclampsia was significantly reduced, compared to their first pregnancies. The number of SGA and stillbirth/neonatal death was also significantly reduced in recurrent pre-eclampsia that was actively managed, compared to their first pregnancies. Conclusion: Despite the small sample size included in this study, our study demonstrates that active obstetric management reduces the incidence of recurrent pre-eclampsia, compared to our previous study, and reduces the severity of recurrent pre-eclampsia. It also improves neonatal outcomes in recurrent pre-eclampsia. However, because of no controls in this study, our findings need to confirmed by a case-control or randomized clinical trial study.