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Simple Prepregnant Prediction Rule for Recurrent Early-onset Hypertensive Disease in Pregnancy

Department of Obstetrics and Gynaecology, University Medical Centre Maastricht and the Research Institute Growth and Development (GROW), Maastricht University, Faculty of Medicine, Department of Epidemiology, School for Public Health and Primary Care (Caphri), Maastricht University, Maastricht, Netherlands

Luc J.M. Smits, PhD

Department of Epidemiology, School for Public Health and Primary Care (Caphri), Maastricht University, Maastricht, Netherlands

Martin H. Prins, MD, PhD

Department of Epidemiology, School for Public Health and Primary Care (Caphri), Maastricht University, Maastricht, Netherlands

Marc E.A. Spaanderman, MD, PhD

Department of Obstetrics and Gynaecology, University Medical Centre, Nijmegen, Netherlands

Louis L.H. Peeters, MD, PhD

Department of Obstetrics and Gynaecology, University Medical Centre Maastricht and the Research Institute Growth and Development (GROW), Maastricht University, Faculty of Medicine

Objective: We aimed to develop a simple clinically useful prediction rule for early-onset recurrent preeclampsia and/or HELLP syndrome. Methods: Women with previous early-onset preeclampsia and/or HELLP, enrolled between 1996 and 2007, and a subsequent ongoing pregnancy were included. Prepregnant cardiovascular, metabolic, renal, and clotting parameters were evaluated as potential predictors for recurrent disease by logistic regression analysis. Results: Early-onset preeclampsia and/or HELLP recurred in 16 (9%) of 186 next pregnancies. The prediction model included high-density lipoprotein (mmol/L) and 24-hour urinary total protein excretion (mg/mmol creatinine). The receiver operating characteristic area was 0.77 (95% confidence interval: 0.68-0.87). Predictive sensitivity and specificity were 94% (69%-99%) and 53% (45%-60%), respectively. Nearly 50% of the women could be classified as having <1% risk of recurrent early-onset disease. Conclusions: The prediction rule identified, with clinically relevant predictive capacity, those women at very low risk for recurrent early-onset disease.

Key Words: Prediction • recurrence • preeclampsia • HELLP syndrome.

Reproductive Sciences, Vol. 16, No. 1, 80-87 (2009)
DOI: 10.1177/1933719108324889


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