(489) History of Offspring Congenital Heart Disease in Pregnancy Increases Risk of Preeclampsia in Subsequent Pregnancy

We conducted a cohort study of births in California (2000-2012) that included two consecutive singleton pregnancies with gestational age of 23-42 weeks. We excluded pregnancies complicated by pre-existing diabetes or major identified chromosomal anomalies (including patent ductus arteriosus and patent foramen ovale). We used multivariable logistic regression to examine the association of fetal CHD in the index pregnancy with preeclampsia in the subsequent pregnancy, and controlled for race/ethnicity, age, education, insurance status, and presence of gestational diabetes. We further examined the association of fetal CHD in the index pregnancy with preterm delivery in patients with preeclampsia.

Results:

Among 985,530 pregnant patients, 2.57% had preeclampsia in the subsequent pregnancy (see figure). Those with a baby with CHD in the index pregnancy had higher rates of preeclampsia in the subsequent pregnancy compared to those without a baby with CHD in the index pregnancy (4.07% vs 2.57 %, p < 0.001). After adjusting for potential confounders, the increased risk of preeclampsia in the subsequent pregnancy persisted (aOR 1.54, 95% CI 1.33-1.77). Among those who had preeclampsia in the subsequent pregnancy, the risk of an early delivery ( < 34 weeks) was higher for patients who had a baby with CHD in the index pregnancy (aOR 1.54, 95% CI 1.16-2.05).

 

Conclusion:

For pregnancies complicated by offspring CHD, there is an increased risk of preeclampsia in the subsequent pregnancy. Among preeclamptic patients, the risk of an early delivery is increased in those who had a baby with CHD in their index pregnancy. These findings suggest a link across pregnancies between offspring cardiac development and preeclampsia for the pregnant patient that is more pronounced, and potentially mechanistically interrelated with earlier preeclampsia.