Abstract: Utility of 1st-trimester Preeclampsia Workup in Women with a History of Preeclampsia

Research project at the Stony Brook Department of OB/GYN under the supervision of Dr. Joseph Chappelle, MD

Abstract selected for poster presentation at the Society for Academic Specialists in General Obstetrics and Gynecology (SASGOG) Annual Meeting 2023

Introduction

Hypertensive disorders of pregnancy (HDOP) are one of the most common complications of pregnancy. Liver enzymes, LDH, creatine, and platelets can be abnormal in women with preeclampsia (PEC) and are a marker for more severe disease. Despite a lack of recommendations, some providers routinely get a “baseline” preeclamptic workup in women with a history of preeclampsia. Our primary objective was to determine how often this workup is abnormal and whether it impacted the clinical care provided.

Methods

We conducted a retrospective observational study of women who received prenatal care at Stony Brook Hospital between 2014-2019. Women with a history of HDOP in a previous pregnancy were included. There were no exclusions. We collected hypertensive diagnosis, laboratory data, blood pressure measurements, and treatments for each woman.

Results

We included 194 women in our analysis, of which 46.9% had gestational hypertension or PEC without severe features in a previous pregnancy, 42.3% had PEC with severe features, 9.3% had superimposed PEC, and 1.5% had eclampsia. Overall, 33.5% of women had a baseline workup performed, which was similar across diagnosis groups. None of the women had abnormal liver enzymes, LDH, or platelet values, while one had an elevated creatinine. A 24-hour urine protein was ordered in 45 (23.2%) women and abnormal in three. In our cohort, 46.4% of women developed a hypertensive disorder in the study pregnancy. Women with chronic hypertension were the highest (77.8%), and the remaining diagnoses had similar reoccurrence rates (32.4%-47.6%).

Conclusion
Women with a history of HDOP did not have abnormal labs in the 1^st-trimester and therefore seemed to offer no clinical value. The literature supports the assessment of proteinuria in the first trimester, especially in women with chronic hypertension, but few women in our cohort received one.