Preeclampsia: what are the risk factors in healthy nulliparous pregnant women?

  • Mayrink J & al.
  • Sci Rep
  • 2 Jul 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In healthy nulliparous pregnant women, ≥0.75 kg weight gain each week, obesity and diastolic blood pressure (DBP) ≥75 mmHg at 20 weeks of gestation were associated with an increased risk for preeclampsia.
  • Pre-eclampsia also led to a higher number of caesarean delivery, prolonged hospitalisation and poor neonatal outcomes.

Why this matters

  • Findings add support to other studies, showing an increased frequency of Caesarean sections, preterm births, neonatal near misses, 5-minute Apgar scores less than 7 and low birth weight in pregnancies complicated by preeclampsia.

Study design

  • This case-control study of 1165 preterm nulliparous pregnant women (19-21 weeks of gestation) derived from a secondary analysis of Preterm SAMBA study included 87 cases of pre-eclampsia matched with 1078 controls.
  • Funding: Preterm SAMBA was supported by the Bill and Melinda Gates Foundation and the Brazilian CNPq.

Key results

  • The incidence of preeclampsia was 7.5% in a nulliparous group of healthy pregnant women.
  • Factors associated with an increased risk of development of pre-eclampsia included:
    • weight gain rate ≥0.75 kg/week (risk ratio [RR], 2.04; 95% CI, 1.12-3.69),
    • obesity (BMI>30.9 kg/m2) (RR, 2.28; 95% CI, 1.39-3.74), and
    • DBP ≥75 mmHg at 20 weeks of gestation (RR, 2.21; 95% CI, 1.30-3.74).
  • Pre-eclampsia led to a higher risk for adverse maternal outcomes:
    • Caesarean delivery (RR, 5.30; 95% CI, 1.25-22.38),
    • Hospitalisation, ≥5 days (RR, 5.80; 95% CI, 2.12-15.91), and
    • Preterm birth
  • In addition, it led to poor perinatal outcomes which included:
    • lower birth weight (mean 379 g lower),
    • small for gestational age (RR, 2.45; 95% CI, 1.52-3.95),
    • 5-minute Apgar score less than 7 (RR, 2.11; 95% CI, 1.03-4.29),
    • neonatal intensive care unit admission (RR, 3.34; 95% CI, 1.61-6.9), and
    • neonatal near miss (RR, 3.65; 95% CI, 1.78-7.49).

Limitations

  • Risk of potential bias.