Recurrent Hypertensive Disorders in Pregnancy

Recurrent hypertensive disorders in pregnancy encompass the repeated development of conditions such as preeclampsia, gestational hypertension and chronic hypertension with superimposed features in successive pregnancies. Women who experience hypertensive disorders in a first pregnancy face a twofold to tenfold increased risk of recurrence, depending on the severity and gestational onset. Early-onset forms, typically associated with placental dysfunction and adverse perinatal outcomes, contrast with late-onset presentations driven by maternal metabolic factors. Genetic predisposition, immunological memory and persistent endothelial dysfunction underpin recurrence, while interpregnancy factors—age, interpregnancy interval, weight change and development of chronic hypertension—influence risk modulation. Recurrence of preeclampsia not only compromises maternal cardiovascular health but also confers increased likelihood of preterm birth, foetal growth restriction and long-term cardiovascular morbidity. Advances in risk stratification, prophylactic low-dose aspirin and interpregnancy lifestyle interventions aim to personalise prevention, with emerging predictive models integrating routine clinical data to guide management in diverse populations worldwide.

Research from Nature Portfolio

Recent studies have established the significance of interpregnancy weight trajectory in modulating recurrence risk. Annual increases in body mass index beyond 1 kg/m2 per year were associated with more than a twofold higher probability of hypertensive disorders in a subsequent pregnancy, independent of prior hypertensive history. This finding emphasises the need for ongoing weight monitoring and counselling between pregnancies, offering a measurable target for interpregnancy care and supporting tailored lifestyle support to mitigate recurrence.

Recurrent Hypertensive Disorders in Pregnancy publication trend

The graph below shows the total number of articles in recurrent hypertensive disorders in pregnancy across all publications each year (not limited to Nature Index journals).

Technical terms

Preeclampsia: A pregnancy-specific syndrome defined by new-onset hypertension and proteinuria or end-organ dysfunction after 20 weeks’ gestation.

Gestational hypertension: Elevated blood pressure developing after 20 weeks’ gestation without proteinuria or end-organ damage.

Chronic hypertension: Hypertension diagnosed before pregnancy or before 20 weeks’ gestation, persistent beyond delivery.

Interpregnancy interval: The duration between delivery of one pregnancy and conception of the next.

Annual BMI gain: The mean yearly change in body mass index calculated over the interpregnancy period.

References

1. Risk of Subsequent Preeclampsia by Maternal Country of Birth: A Norwegian Population-Based Study. International Journal of Environmental Research and Public Health (2023).
2. Risk of pre-eclampsia in first and subsequent pregnancies: prospective cohort study. The BMJ (2009).
3. Epidemiology of Pregnancy Complications Through the Lens of Immunological Memory. Frontiers in Immunology (2021).
4. Annual body mass index gain and risk of hypertensive disorders of pregnancy in a subsequent pregnancy. Scientific Reports (2021).
5. Does Developing Interpregnancy Hypertension Affect the Recurrence Risk of Preeclampsia? A Population-Based Cohort Study. American Journal of Hypertension (2024).
6. Visualizing risk modification of hypertensive disorders of pregnancy: development and validation of prediction model for personalized interpregnancy weight management. Hypertension Research (2024).
7. Common pathogenesis of early and late preeclampsia: evidence from recurrences and review of the literature. Archives of Gynecology and Obstetrics (2023).