Warn patients about heart risks after preeclampsia: preeclampsia is a manifestation of underlying silent disease that will develop later into a clinical condition.(Obstetrics)

NEW YORK -- Women who develop preeclampsia should be counseled about the risk in subsequent gestations and strategies to contain these risks, according to Baha M. Sibai, M.D.

In addition, more general implications about health in later life should be discussed with the patient, said Dr. Sibai, who is professor and chairman of obstetrics and gynecology at the University of Cincinnati.

He made his report at an obstetrics symposium sponsored by Columbia University and New York Presbyterian Hospital.

About 20%-30% of women who have had an episode of preeclampsia will develop the disorder in a subsequent pregnancy, which makes this history at least as significant a risk factor for future preeclampsia as chronic hypertension, renal disease, and pregestational diabetes.

The earlier in the first gestation preeclampsia developed, the higher the risk of recurrence in the next: the condition returned in more than half of women who had their first episode before week 27, compared with a 40% recurrence when the index episode was between week 27 and 30, and 20% at week 37 or after.

A severe episode of preeclampsia or eclampsia also is associated with a worse outcome in subsequent pregnancies, with an increased risk of intrauterine growth retardation, perinatal loss, and abruptio placentae. Here, too, the earlier the episode occurred in the first gestation, the greater the risk to the second, Dr. Sibai said.

Preventive measures can contain the risk of preeclampsia and poor outcome in subsequent pregnancies. These include attention to weight, blood pressure, and blood sugar.