Assessment of the risk of giving birth to a baby of low weight for gestational age in pregnant women with a history of preeclampsia

• Svetlana A. Galeeva
• Svetlana F. Nasyrova
• Irina B. Fatkullina
• Evgeny M. Gareev
• Najiba A. Tajiboeva
• Natalia А. Stetsenko
• Dinara G. Sitdikova

Abstract

The aims of the study: 1) to evaluate the incidence of intrauterine growth restriction syndrome (IGR) and the frequency of uteroplacental hemodynamics disorders in pregnant women with a gestational history of preeclampsia (PE), depending on the occurrence of a relapse of PE; 2) in a group of patients with a history of PE, assess the risk of having a baby of low weight for gestational age, even in the absence of recurrent preeclampsia.

Material and methods. The data obtained on patients with late and early PE in the anamnesis (of 31 cases in each group) and 32 cases with uncomplicated pregnancy (control group) were analyzed. In the group with late PE manifestation, relapse occurred in the overwhelming number of patients – in 28 cases out of 31 (90%), and in the group with early PE manifestation, the proportion of relapses and their absence was almost mirror – 4 cases out of 31 (13%) versus 27 (87%). Both groups differed significantly in the nature of the manifestation of recurrent PE. In late manifestations of PE, out of 28 cases of relapse, the overwhelming part, 25 (89%) referred to moderate PE and only 2 (7%) cases to severe PE. In the group with early manifestation of PE, on the contrary, all 4 cases were severe. Thus, the groups with late and early manifestations of PE differed significantly both in the proportion of relapses and in the distribution of relapses by severity.

Results and discussion. In the group of pregnant women with a gestational history of preeclampsia with the development of a severe form of relapse of preeclampsia, a significant increase in the number of the formation of SSDs and circulatory disorders in the mother-placenta-fetus system was revealed. The patients belonging to the control group, the groups with no relapse and the manifestation of relapse of moderate and severe degree had a significant effect on the average fetal weight (F=11.7, p<0.0001). The highest average weight (3513±430 g) occurred in the control group. This level was significantly (p>0.04) higher than the average weight in the group with no relapse (3175±302 g).The lowest fetal weight (2601±691 g) occurred in severe relapses. It turned out to be significantly lower than in the other groups: the control group, without a recurrence of PE, and with a recurrence of PE of moderate severity (p<0.003÷<0.0001). To a certain extent, similar ratios were observed with respect to the average size (height) of the fetus, whose dependence on group membership turned out to be less rigid than in the case of weight (F=3.3, p<0.03). This dependence is mainly due to a small but significant (p<0.004) difference between the average fetal growth in the control group (52.6±2.1 cm) and with relapses of severe PE (50.1±4.2 cm). Attention is also drawn to the fact that the average fetal growth in the absence of relapse and relapses of moderate severity almost coincides (51.3±2.5 and 51.4±2.6 cm, respectively).

Conclusions. 1. In the group of pregnant women with severe relapse of PE, a significant increase in the formation of IGR and disorders of uteroplacental hemodynamics. 2. In the group of pregnant women with early and late preeclampsia in the gestational history, subsequent pregnancy is characterized by the birth of a child with a significantly low average height and weight (compared with the control group), regardless of the presence of a recurrence of PE.

Keywords:preeclampsia; relapse of preeclampsia; intrauterine growth restriction syndrome; circulatory disorders in the mother-placenta-fetus system; the fetus is small for gestational age

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