Investigate the Effects of Preeclampsia Severity, Race and Fetal Sex on Subsequent Maternal Complications Using EHR Data From Over 100,000 Pregnancies

ABSTRACT Preeclampsia (PE) is a major pregnancy complication associated with long‐term maternal health risks, but how these risks vary by severity, race, and fetal sex is unclear. To identify maternal complications after PE and to evaluate the modifying effects of severity, race, and fetal sex, we conducted a retrospective cohort study of over 100,000 patients from four medical centers (UM, UK Biobank, Cedars‐Sinai, Vanderbilt). The discovery cohort included 26,632 UM patients; validation cohorts included 15,313 UK Biobank, 29,821 Cedars‐Sinai, and 31,418 Vanderbilt patients. Thirty potential complications within 10 years postpartum were assessed using confounder‐adjusted logistic regression. Complications persisting ≥ 5 years were further analyzed with Kaplan–Meier survival. Five complications were consistently associated with PE: hypertension, renal failure, diabetes (complicated or uncomplicated), and obesity. Among them, hypertension (median OR = 6.05) and renal failure (median OR = 4.92) showed the strongest associations. Severe PE was linked to earlier and higher risk of hypertension and renal failure. African Americans had lower relative hypertension risk but higher renal failure risk than Caucasians. Fetal sex appeared to modify outcomes: male fetuses conferred a higher maternal hypertension risk but a lower renal failure risk compared with female fetuses.