Recurrent Risk of Adverse Pregnancy Outcome

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It is an unfortunate fact that all pregnancies do not end with healthy babies and healthy mothers. Families who have experienced an adverse pregnancy outcome require accurate information about the risk of recurrence to plan future childbearing. This article examines the recurrence risk of four complications of pregnancy: gestational diabetes, preterm delivery, stillbirth, and preeclampsia. Combined, these four complications are responsible for approximately 24% of maternal and neonatal morbidity and mortality.

Section snippets

Gestational diabetes

GDM is glucose intolerance with onset or first recognition during pregnancy. Between 2% and 5% of all pregnancies are complicated by GDM. Current thinking is that GDM and Type 2 diabetes are the same disease. The two diseases share common risk factors and both are characterized by insulin resistance [1], [2], [3], [4].

The recurrence rate of GDM is between 35% and 75%. Risk factors for recurrence include high prepregnancy body mass index (BMI), birth weight greater than or equal to 4 kg in

Preterm delivery

Preterm delivery is delivery occurring before 37 weeks gestation. Very early preterm delivery (<34 weeks) is associated with significant neonatal morbidity and mortality [12].

The incidence of preterm delivery is estimated between 7% and 12% of all deliveries. One third of all preterm births occur before 34 weeks [13], [14]. The cause of preterm delivery is multifactorial and medical and social factors overlap.

Stillbirth

Stillbirth is defined as the birth of a nonliving fetus after 20 weeks gestation. If gestational age is unknown a birth weight of 500 g or more constitutes a stillbirth.

The rate of stillbirth in the United States is approximately 6.4 per 1000 births [31], [32]. Thirty percent of stillbirths can be attributed to abnormalities of the placenta, umbilical cord, or fetal membranes. Ten percent are caused by underlying maternal disease. Twenty-five percent are from fetal causes, such as aneuploidy,

Preeclampsia

Preeclampsia affects between 5% and 7% of all pregnancies and is responsible for 7% to 15% of maternal mortality [43], [44]. Neonatal outcomes are directly related to iatrogenic prematurity, although uteroplacental insufficiency may also be associated with the disease.

The cause of preeclampsia is unknown. It is unique to human pregnancy and the only known cure is cessation of pregnancy, although temporizing measures are often undertaken. The rate of recurrence is cited between 0% and 60% [45],

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