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Predicting Preeclampsia in the Second Pregnancy from Low Birth Weight in the First Pregnancy

From the Medical Birth Registry of Norway, the Department of Obstetrics and Gynecology, University of Bergen, Bergen, Norway, and the Department of Obstetrics and Gynecology, Aker University Hospital, Oslo, Norway.

Address reprint requests to: Svein Rasmussen, MD, PhD Haukeland University Hospital Medical Birth Registry of Norway Armauer Hansen Building N-7800 Bergen Norway E-mail: svein.rasmussen{at}mfr.uib.no

Objective: To evaluate the effect of low birth weight adjusted for gestational age in first pregnancies on preeclampsia in second pregnancies and to estimate the proportion of preeclampsia in second pregnancies attributable to histories of LBW for gestational age.

Methods: We conducted a cohort study based on linked data from the Medical Birth Registry of Norway, which covered all births in 1967–1992.

Results: Women who delivered infants under the third percentile birth weight were three times more likely to have initial or recurrent preeclampsia in second pregnancies than those who delivered infants at or above the tenth percentile. After adjusting for maternal age, year of birth, interpregnancy interval, education, chronic hypertension, diabetes mellitus, and change of partner, the increased risk persisted. Birth weight below the tenth percentile in the first delivery accounted for 10% of the total cases of preeclampsia in the second pregnancy and 30% of recurrent cases.

Conclusion: A history of low birth weight adjusted for gestational age is associated significantly with subsequent occurrence as well as recurrence of preeclampsia. These findings are consistent with the hypothesis of a shared etiologic factor or recurrent pathophysiologic mechanism for preeclampsia and fetal growth restriction. A history of fetal smallness for gestational age is found in a substantial proportion of all cases of preeclampsia and thus seems to be important in the etiology of preeclampsia.

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