Comparison of risk factors and outcomes of gestational hypertension and pre-eclampsia

Abstract

Background: It remains an enigma whether gestational hypertension (GH) and pre-eclampsia (PE) are distinct entities or different spectrum of the same disease. We aimed to compare the risk factors and outcomes between GH and PE.

Method: A total of 7,633 pregnant women recruited between 12 and 20 weeks of gestation in the Ottawa and Kingston Birth Cohort from 2002 to 2009 were included in the analysis. Cox proportional hazards model was used to identify and compare the risk factors for GH and PE by treating gestational age at delivery as the survival time. Logistic regression model was used to compare outcome. Subgroup analysis was performed for early- and late-onset PE.

Results: GH and PE shared most risk factors including overweight and obesity, nulliparity, PE history, type 1 and 2 diabetes, and twin birth. Effect size of PE history (RR = 14.1 for GH vs. RR = 6.4 for PE) and twin birth (RR = 4.8 for GH vs. RR = 10.3 for PE) showed substantial difference. Risk factors modified gestational age at delivery in patients with GH and PE in similar pattern. Subgroup analysis showed that early- and late-onset PE shared some risk factors with different effect sizes, whereas folic acid supplementation showed protective effect for early-onset PE only. PE was strongly associated with several adverse outcomes including cesarean section, placental abruption, small for gestational age, preterm birth, and 5 min Apgar score < 7, whereas GH was associated with increased risk of preterm birth only.

Conclusions: GH and PE shared common risk factors. Differences in effect sizes of risk factors and outcomes indicate that the conditions may have different pathophysiology and mechanism.

Fig 1. Survival curves for cumulative incidences of gestational hypertension and pre-eclampsia, stratified by common risk factors.

Survival curves stratified by BMI (a, b), parity and pre-eclampsia history (c, d), diabetes (e, f) and number of babies (g, h), adjusted by age, race, education, household income, smoking, folic acid supplementation, BMI, parity, pre-eclampsia history, conception through assisted reproductive technologies, diabetes, infant sex, and number of babies. Risk factors modified the average GA in women with GH and PE in similar patterns. The survival curves were left-shifted in high-risk women (overweight or obese, nulliparous, or with PE history) compared with those in low-risk women (normal-weight, parous, or without PE history). The curves for PE were also left-shifted compared with the curves for GH.