Social deprivation and pre-eclampsia recurrence: the nationwide conception study

Objective: The recurrence rate of pre-eclampsia in a subsequent pregnancy ranges between 10 and 20% in the literature. We aimed to study the association between social deprivation and the prevention and recurrence of preeclampsia. Design and method: All women of the nationwide Conception study (elaborated from French National Health Insurance Information System) who gave birth for the first time in France in 2010-2018, and who subsequently gave birth in the same period were included. Pre-eclampsia was identified through hospital diagnoses. Aspirin deliveries during the second pregnancy were collected to assess the rate and timing of initiation, and the treatment adherence. All medical consultations in the year before the beginning of their second pregnancy and until 20 weeks of gestation were identified. Women who benefitted from Universal Medical Coverage providing free access to health care for people with an annual income less than 60% of the poverty threshold were defined as living in social deprivation. The adjusted incidence rate ratios (aIRR) of preeclampsia during the second pregnancy were estimated using Poisson models adjusted for confounding Results: Of the 2,829,274 women included, 31,956 (1.9%) were diagnosed with a pre-eclampsia during their first pregnancy. From those, 4,697 (14.7%) had recurrent pre-eclampsia during the second pregnancy. Women living in social deprivation had more cardiovascular risk factors, were less likely to consult a physician in the year before and until 20 weeks of gestation (90.3% vs 97.5%), to receive prescribed aspirin at least once during their second pregnancy (33.7 vs 45.7%), to begin the treatment before 16 week of gestation (81.4 vs 90.7% among those receiving at least one delivery of aspirin during pregnancy), and to be adherent to therapy throughout the pregnancy (44.6 vs 55.9%). In multivariate analyses, women living in social deprivation were less likely to initiate aspirin during the second pregnancy (aIRR = 0.74 [0.70-0.78] and had a higher risk of pre-eclampsia recurrence (aIRR = 1.31 [1.28-1.33]). Conclusions: Greater efforts should be made to improve the medical monitoring and prevention strategies of socially deprived women with pre-eclampsia because of their high risk of recurrence.