Risk Factors, Complications, and Outcome of Early and Late Onset Pre-Eclampsia in a Tertiary Care Hospital: Early vs Late Onset Pre-Eclampsia: Risk Factors and Outcomes

Komal Saleem; Riffat Jaleel; Farah Naz; Hira Sagheer; Sania Shoaib

doi:10.54393/pjhs.v7i9.4106

Authors

Komal Saleem Department of Gynecology and Obstetrics, Dr. Ruth K. M. Pfau, Civil Hospital Karachi /Dow University of Health Sciences, Karachi, Pakistan
Riffat Jaleel Department of Gynecology and Obstetrics, Dr. Ruth K. M. Pfau, Civil Hospital Karachi /Dow University of Health Sciences, Karachi, Pakistan
Farah Naz Department of Gynecology and Obstetrics, Dr. Ruth K. M. Pfau, Civil Hospital Karachi /Dow University of Health Sciences, Karachi, Pakistan
Hira Sagheer Department of Gynecology and Obstetrics, Dr. Ruth K. M. Pfau, Civil Hospital Karachi /Dow University of Health Sciences, Karachi, Pakistan
Sania Shoaib Department of Gynecology and Obstetrics, Dr. Ruth K. M. Pfau, Civil Hospital Karachi /Dow University of Health Sciences, Karachi, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v7i9.4106

Keywords:

Early-Onset Preeclampsia, Maternal Complications, Neonatal Outcomes, Late-Onset Preeclampsia

Abstract

Early-onset preeclampsia is linked to a greater number of maternal and neonatal complications than late-onset preeclampsia. Objective: To evaluate the risk factors, maternal complications, and neonatal outcomes associated with early- versus late-onset preeclampsia in a tertiary care setting. Methods: A 4-month comparative analytical study was performed at the Gynecology Ward at Civil Hospital, Karachi, from October 2025 to January 2026. The study included 90 pregnant women with hypertensive disorders of pregnancy who were recruited (45 EO-PE and 45 LO-PE). Women aged between 15 and 40 years old who spontaneously conceived without artificial insemination were eligible. SPSS version 26 was used to analyze the data. Associations were investigated using descriptive statistics. Associations were evaluated using binary logistic regression; a p-value <0.05 was considered statistically significant. Results: The mean age of women with early-onset preeclampsia was 28.6 ± 5.4 years compared with 29.2 ± 5.1 years among those with late-onset preeclampsia, while an interpregnancy interval >10 years was also more frequent among eligible multiparous women with early-onset preeclampsia (56.5% vs. 24.0%; p=0.013).. EO-PE was correlated with more maternal complications, such as abruption placentae (15.6% vs. 2.2, p=0.020), HELLP syndrome (11.1% vs. 0%, p=0.010), and eclampsia (8.9% vs. 0%, p=0.040). Neonates born to EO-PE mothers were found to have lower birth weights (2.25 =0.45 kg vs. 2.78 =0.38 kg, p=0.001) and increased NICU admissions (46.7% vs. 20%, p=0.007). EO-PE was found to increase the odds of both maternal complications and NICU admission. Conclusion: Preeclampsia in the first trimester is linked with increased maternal and neonatal risks compared to those experienced in the latter.

References

Rahman L, Anwar R, Mose JC. Maternal and Neonatal Outcome Among Women with Early-Onset Preeclampsia and Late-Onset Preeclampsia. Hypertension in pregnancy. 2024 Dec 31;43(1):2405991. doi: 10.1080/10641955.2024.2405991. DOI: https://doi.org/10.1080/10641955.2024.2405991

Onishi K, Seagraves E, Baraki D, Donaldson T, Barake C, Abuhamad A et al. Risk Factors for Early-and Late-Onset Superimposed Preeclampsia. American Journal of Perinatology. 2024 May; 41(1): 2073-2080. doi: 10.1055/a-2096-5052. DOI: https://doi.org/10.1055/a-2096-5052

Bakht F, Shahid R, Afzal M, Ashraf K, Khalid A, Hayat A et al. Prevalence and Characteristics of Early vs. Late-Onset Preeclampsia: A Cross-Sectional Descriptive Study: Prevalence and Characteristics of Early vs. Late-Onset Preeclampsia. Pakistan Journal of Health Sciences. 2025 Jun: 223-226. doi: 10.54393/pjhs.v6i6.2987. DOI: https://doi.org/10.54393/pjhs.v6i6.2987

Hauge MG, Linde JJ, Kofoed KF, Ersbøll AS, Johansen M, Sigvardsen PE et al. Early-Onset vs Late-Onset Preeclampsia and Risk of Coronary Atherosclerosis Later in Life: A Clinical Follow-Up Study. American journal of obstetrics and gynecology MFM. 2024 May; 6(5): 101371. doi: 10.1016/j.ajogmf.2024.101371. DOI: https://doi.org/10.1016/j.ajogmf.2024.101371

Kariori M, Katsi V, Tsioufis C. Late vs. Early Preeclampsia. International Journal of Molecular Sciences. 2025 Nov; 26(22): 11091. doi:10.3390/ijms262211091. DOI: https://doi.org/10.3390/ijms262211091

Suksai M, Geater A, Amornchat P, Suntharasaj T, Suwanrath C, Pruksanusak N. Preeclampsia and Timing of Delivery: Disease Severity, Maternal and Perinatal Outcomes. Pregnancy Hypertension. 2024 Sep; 37: 101151. doi: 10.1016/j.preghy.2024.101151. DOI: https://doi.org/10.1016/j.preghy.2024.101151

Robillard PY, Dekker G, Scioscia M, Bonsante F, Boukerrou M, Iacobelli S et al. Preeclampsia in 2023: Time for Preventing Early Onset and Term Preeclampsia: The Paramount Role of Gestational Weight Gain. Journal of Reproductive Immunology. 2023 Aug; 158: 103968. doi: 10.1016/j.jri.2023.103968. DOI: https://doi.org/10.1016/j.jri.2023.103968

Harjai US and Junnare KK. Maternal and Fetal Outcomes in Early-Onset vs. Late-Onset Preeclampsia: A Retrospective Study at a Tertiary Care Institute in India. Cureus. 2026 Jan; 18(1): 1-11. doi: 10.7759/cureus.102711. DOI: https://doi.org/10.7759/cureus.102711

Teka H, Yemane A, Abraha HE, Berhe E, Tadesse H, Gebru F et al. Clinical Presentation, Maternal-Fetal, and Neonatal Outcomes of Early-Onset Versus Late-Onset Preeclampsia-Eclampsia Syndrome in a Teaching Hospital in a Low-Resource Setting: A Retrospective Cohort Study. PloS one. 2023 Feb; 18(2): 281952. doi: 10.1371/journal.pone.0281952. DOI: https://doi.org/10.1371/journal.pone.0281952

von Dadelszen P, Syngelaki A, Akolekar R, Magee LA, Nicolaides KH. Preterm and term pre‐eclampsia: Relative burdens of maternal and perinatal complications. An International Journal of Obstetrics and Gynaecology. 2023 Apr; 130(5): 524-530. doi: 10.1111/1471-0528.17370. DOI: https://doi.org/10.1111/1471-0528.17370

Wadhwani P, Saha PK, Kalra JK, Gainder S, Sundaram V. A Study to Compare Maternal and Perinatal Outcome in Early Vs. Late-Onset Preeclampsia. Obstetrics and Gynecology Science. 2020 May; 63(3): 270-7. doi: 10.5468/ogs.2020.63.3.270. DOI: https://doi.org/10.5468/ogs.2020.63.3.270

Gangadhar L, Rengaraj S, Thiyagalingam S, Bethou A. Maternal and Perinatal Outcome of Women with Early‐Onset Severe Pre‐Eclampsia Before 28 Weeks: Is Expectant Management Beneficial in a Low‐Resource Country? A Prospective Observational Study. International Journal of Gynecology and Obstetrics. 2023 Jun; 161(3): 1075-1082. doi: 10.1002/ijgo.14642. DOI: https://doi.org/10.1002/ijgo.14642

Niu Y, Suo L, Zhao D, Wang Y, Miao R, Zou J et al. Is Artificial Endometrial Preparation More Associated with Early-Onset or Late-Onset Preeclampsia After Frozen Embryo Transfer? Journal of Assisted Reproduction and Genetics. 2023 May; 40(5): 1045-1054. doi: 10.1007/s10815-023-02785-0. DOI: https://doi.org/10.1007/s10815-023-02785-0

Susilo SA, Pratiwi KN, Fattah AN, Irwinda R, Wibowo N. Determinants of Low APGAR Score Among Preeclamptic Deliveries in Cipto Mangunkusumo Hospital: A Retrospective Cohort Study in 2014. Medical Journal of Indonesia. 2015 Nov; 24(3): 183-189. doi: 10.13181/mji.v24i3.1229. DOI: https://doi.org/10.13181/mji.v24i3.1229

van Esch JJ, van Heijst AF, de Haan AF, van der Heijden OW. Early-Onset Preeclampsia is Associated with Perinatal Mortality and Severe Neonatal Morbidity. The Journal of Maternal-Fetal and Neonatal Medicine. 2017 Dec; 30(23): 2789-2794. doi: 10.1080/14767058.2016.1263295. DOI: https://doi.org/10.1080/14767058.2016.1263295

Ramesh V. Fetal and Neonatal Outcomes in Early Onset Versus Late Onset Pre-Eclampsia: A Comparative Study. International Journal of Contemporary Pediatrics. 2021; 8(5): 900–903. doi: 10.18203/2349-3291.ijcp20211683. DOI: https://doi.org/10.18203/2349-3291.ijcp20211683

Henderson JT, Thompson JH, Burda BU, Cantor A. Preeclampsia Screening: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2017 Apr; 317(16): 1668-1684. doi: 10.1001/jama.2016.18315. DOI: https://doi.org/10.1001/jama.2016.18315

Ananth CV, Brandt JS, Hill J, Graham HL, Grover S, Schuster M et al. Historical and recent changes in maternal mortality due to hypertensive disorders in the United States, 1979 to 2018. Hypertension. 2021 Nov; 78(5): 1414-1422. doi: 10.1161/HYPERTENSIONAHA.121.17661. DOI: https://doi.org/10.1161/HYPERTENSIONAHA.121.17661

McElrath TF, Jeyabalan A, Khodursky A, Moe AB, Lee M, Jain M et al. Utility of the US Preventive Services Task Force for Preeclampsia Risk Assessment and Aspirin Prophylaxis. JAMA Network Open. 2025 Jul; 8(7): 2521792. doi: 10.1001/jamanetworkopen.2025.21792. DOI: https://doi.org/10.1001/jamanetworkopen.2025.21792

Elawad T, Scott G, Bone JN, Elwell H, Lopez CE, Filippi V, Green M, Khalil A, Kinshella ML, Mistry HD, Pickerill K. Risk factors for pre‐eclampsia in clinical practice guidelines: comparison with the evidence. BJOG: An International Journal of Obstetrics and Gynaecology. 2024 Jan; 131(1): 46-62. doi: 10.1111/1471-0528.17320. DOI: https://doi.org/10.1111/1471-0528.17320

Li X, Kang F, Li X, Du X, Yang Y. Comparison of Characteristics Between Early-Onset and Late-Onset Severe Preeclampsia: A Retrospective Cohort Study from a Tertiary Hospital in China. Reproductive Sciences. 2025 Jan; 32(1): 139-149. doi: 10.1007/s43032-024-01674-w. DOI: https://doi.org/10.1007/s43032-024-01674-w