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==Risk factors== | ==Risk factors== | ||
*History of [[pre-eclampsia]]/[[eclampsia]]: Personal history of a similar event in the past or family history is a significant risk factor for recurrence in the next pregnancy. Having pre-eclampsia in one pregnancy is a strong predictor for recurrence of pre-eclampsia in future gestations. The risk for women to develop pre-eclampsia during the second pregnancy is approximately 15% if the first pregnancy was affected by pre-eclampsia and 1.1% for those without a history of pre-eclampsia. The risk during the third pregnancy is approximately 30% for women who have had two previous affected pregnancies and remains 1.1% for those without any history. For women with the first occurrence of pre-eclampsia in their second pregnancy, the risk was 15.9% during the third pregnancy and 29.0% during the fourth when they had developed pre-eclampsia in the previous two pregnancies.<ref name="pmid19541696">{{cite journal| author=Hernández-Díaz S, Toh S, Cnattingius S| title=Risk of pre-eclampsia in first and subsequent pregnancies: prospective cohort study. | journal=BMJ | year= 2009 | volume= 338 | issue= | pages= b2255 | pmid=19541696 | doi=10.1136/bmj.b2255 | pmc=3269902 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19541696 }} </ref> | |||
*[[Nulliparity]]: The risk for [[multiparous]] women without a history of pre-eclampsia was around 1%.<ref name="pmid19541696">{{cite journal| author=Hernández-Díaz S, Toh S, Cnattingius S| title=Risk of pre-eclampsia in first and subsequent pregnancies: prospective cohort study. | journal=BMJ | year= 2009 | volume= 338 | issue= | pages= b2255 | pmid=19541696 | doi=10.1136/bmj.b2255 | pmc=3269902 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19541696 }} </ref> | *'''History of [[pre-eclampsia]]/[[eclampsia]]:''' Personal history of a similar event in the past or family history is a significant risk factor for recurrence in the next pregnancy. Having pre-eclampsia in one pregnancy is a strong predictor for recurrence of pre-eclampsia in future gestations. The risk for women to develop pre-eclampsia during the second pregnancy is approximately 15% if the first pregnancy was affected by pre-eclampsia and 1.1% for those without a history of pre-eclampsia. The risk during the third pregnancy is approximately 30% for women who have had two previous affected pregnancies and remains 1.1% for those without any history. For women with the first occurrence of pre-eclampsia in their second pregnancy, the risk was 15.9% during the third pregnancy and 29.0% during the fourth when they had developed pre-eclampsia in the previous two pregnancies.<ref name="pmid19541696">{{cite journal| author=Hernández-Díaz S, Toh S, Cnattingius S| title=Risk of pre-eclampsia in first and subsequent pregnancies: prospective cohort study. | journal=BMJ | year= 2009 | volume= 338 | issue= | pages= b2255 | pmid=19541696 | doi=10.1136/bmj.b2255 | pmc=3269902 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19541696 }} </ref> | ||
*[[Primigravida]]: The risk of pre-eclampsia is 4.1% in the first pregnancy and 1.7% in later pregnancies overall if none of the previous pregnancies have been affected by pre-eclampsia.<ref name="pmid19541696">{{cite journal| author=Hernández-Díaz S, Toh S, Cnattingius S| title=Risk of pre-eclampsia in first and subsequent pregnancies: prospective cohort study. | journal=BMJ | year= 2009 | volume= 338 | issue= | pages= b2255 | pmid=19541696 | doi=10.1136/bmj.b2255 | pmc=3269902 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19541696 }} </ref> This association is the core of theory that says that pre-eclampsia is the consequence of a maternal immune reaction against paternal antigens expressed in the placenta which might result in defective trophoblast invasion and subsequent placental dysfunction. The lower risk of pre-eclampsia among multiparous women has been attributed to desensitisation after exposure to paternal antigens in the placenta during previous pregnancies.<ref name="pmid17593196">{{cite journal| author=Luo ZC, An N, Xu HR, Larante A, Audibert F, Fraser WD| title=The effects and mechanisms of primiparity on the risk of pre-eclampsia: a systematic review. | journal=Paediatr Perinat Epidemiol | year= 2007 | volume= 21 Suppl 1 | issue= | pages= 36-45 | pmid=17593196 | doi=10.1111/j.1365-3016.2007.00836.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17593196 }} </ref><ref name="pmid12796047">{{cite journal| author=Saftlas AF, Levine RJ, Klebanoff MA, Martz KL, Ewell MG, Morris CD | display-authors=etal| title=Abortion, changed paternity, and risk of preeclampsia in nulliparous women. | journal=Am J Epidemiol | year= 2003 | volume= 157 | issue= 12 | pages= 1108-14 | pmid=12796047 | doi=10.1093/aje/kwg101 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12796047 }} </ref> and to smoother trophoblastic invasion after modification of maternal spiral arteries during the first pregnancy.<ref name="pmid6411232">{{cite journal| author=Moore MP, Redman CW| title=Case-control study of severe pre-eclampsia of early onset. | journal=Br Med J (Clin Res Ed) | year= 1983 | volume= 287 | issue= 6392 | pages= 580-3 | pmid=6411232 | doi=10.1136/bmj.287.6392.580 | pmc=1548969 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6411232 }} </ref> For this reason pre-eclampsia is also known as ''a disease of primiparity''. | *'''[[Nulliparity]]''': The risk for [[multiparous]] women without a history of pre-eclampsia was around 1%.<ref name="pmid19541696">{{cite journal| author=Hernández-Díaz S, Toh S, Cnattingius S| title=Risk of pre-eclampsia in first and subsequent pregnancies: prospective cohort study. | journal=BMJ | year= 2009 | volume= 338 | issue= | pages= b2255 | pmid=19541696 | doi=10.1136/bmj.b2255 | pmc=3269902 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19541696 }} </ref> | ||
*Interpregnancy interval: A long interpregnancy interval is associated with increased risk of preeclampsia, supporting the hypothesis that some factors delaying clinically recognized conception may also be in a causal pathway for preeclampsia.<ref name="pmid12543618">{{cite journal| author=Basso O, Weinberg CR, Baird DD, Wilcox AJ, Olsen J, Danish National Birth Cohort| title=Subfecundity as a correlate of preeclampsia: a study within the Danish National Birth Cohort. | journal=Am J Epidemiol | year= 2003 | volume= 157 | issue= 3 | pages= 195-202 | pmid=12543618 | doi=10.1093/aje/kwf194 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12543618 }} </ref> | *'''[[Primigravida]]''': The risk of pre-eclampsia is 4.1% in the first pregnancy and 1.7% in later pregnancies overall if none of the previous pregnancies have been affected by pre-eclampsia.<ref name="pmid19541696">{{cite journal| author=Hernández-Díaz S, Toh S, Cnattingius S| title=Risk of pre-eclampsia in first and subsequent pregnancies: prospective cohort study. | journal=BMJ | year= 2009 | volume= 338 | issue= | pages= b2255 | pmid=19541696 | doi=10.1136/bmj.b2255 | pmc=3269902 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19541696 }} </ref> This association is the core of theory that says that pre-eclampsia is the consequence of a maternal immune reaction against paternal antigens expressed in the placenta which might result in defective trophoblast invasion and subsequent placental dysfunction. The lower risk of pre-eclampsia among multiparous women has been attributed to desensitisation after exposure to paternal antigens in the placenta during previous pregnancies.<ref name="pmid17593196">{{cite journal| author=Luo ZC, An N, Xu HR, Larante A, Audibert F, Fraser WD| title=The effects and mechanisms of primiparity on the risk of pre-eclampsia: a systematic review. | journal=Paediatr Perinat Epidemiol | year= 2007 | volume= 21 Suppl 1 | issue= | pages= 36-45 | pmid=17593196 | doi=10.1111/j.1365-3016.2007.00836.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17593196 }} </ref><ref name="pmid12796047">{{cite journal| author=Saftlas AF, Levine RJ, Klebanoff MA, Martz KL, Ewell MG, Morris CD | display-authors=etal| title=Abortion, changed paternity, and risk of preeclampsia in nulliparous women. | journal=Am J Epidemiol | year= 2003 | volume= 157 | issue= 12 | pages= 1108-14 | pmid=12796047 | doi=10.1093/aje/kwg101 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12796047 }} </ref> and to smoother trophoblastic invasion after modification of maternal spiral arteries during the first pregnancy.<ref name="pmid6411232">{{cite journal| author=Moore MP, Redman CW| title=Case-control study of severe pre-eclampsia of early onset. | journal=Br Med J (Clin Res Ed) | year= 1983 | volume= 287 | issue= 6392 | pages= 580-3 | pmid=6411232 | doi=10.1136/bmj.287.6392.580 | pmc=1548969 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6411232 }} </ref> For this reason pre-eclampsia is also known as ''a disease of primiparity''. | ||
*Conditions with a large placenta: | *'''Interpregnancy interval:''' A long interpregnancy interval is associated with increased risk of preeclampsia, supporting the hypothesis that some factors delaying clinically recognized conception may also be in a causal pathway for preeclampsia.<ref name="pmid12543618">{{cite journal| author=Basso O, Weinberg CR, Baird DD, Wilcox AJ, Olsen J, Danish National Birth Cohort| title=Subfecundity as a correlate of preeclampsia: a study within the Danish National Birth Cohort. | journal=Am J Epidemiol | year= 2003 | volume= 157 | issue= 3 | pages= 195-202 | pmid=12543618 | doi=10.1093/aje/kwf194 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12543618 }} </ref> | ||
**[[Multiple gestations]]: The relative risk of preterm preeclampsia in [[di-chorionic]] and [[mono-chorionic twin]] pregnancies is similar and substantially higher than in singleton pregnancies. In a study, it was found that the incidence of pre-eclampsia in singleton pregnancies was 2.3% compared to 8% in dichorionic(DC) twin pregnancies and 6% in monochorionic(MC) twin pregnancies. Compared to singletons, the relative risk of total pre-eclampsia was 3.5 for DC twins and 2.6 for MC twins.<ref>Francisco, C., Wright, D., Benkő, Z., Syngelaki, A. and Nicolaides, K.H. (2017), Hidden high rate of pre-eclampsia in twin compared with a singleton pregnancy. Ultrasound Obstet Gynecol, 50: 88-92. https://doi.org/10.1002/uog.17470</ref> | *'''Conditions with a large placenta:''' | ||
**[[Hydatiform mole]] | **'''[[Multiple gestations]]:''' The relative risk of preterm preeclampsia in [[di-chorionic]] and [[mono-chorionic twin]] pregnancies is similar and substantially higher than in singleton pregnancies. In a study, it was found that the incidence of pre-eclampsia in singleton pregnancies was 2.3% compared to 8% in dichorionic(DC) twin pregnancies and 6% in monochorionic(MC) twin pregnancies. Compared to singletons, the relative risk of total pre-eclampsia was 3.5 for DC twins and 2.6 for MC twins.<ref>Francisco, C., Wright, D., Benkő, Z., Syngelaki, A. and Nicolaides, K.H. (2017), Hidden high rate of pre-eclampsia in twin compared with a singleton pregnancy. Ultrasound Obstet Gynecol, 50: 88-92. https://doi.org/10.1002/uog.17470</ref> | ||
*Women with preexisting [[vascular diseases]]: | **[[Hydatiform mole|'''Hydatiform mole''']] | ||
*'''Women with preexisting [[vascular diseases]]:''' | |||
**[[Chronic hypertension]]: Chronic hypertension is defined as high blood pressure present before pregnancy or before 20 weeks of pregnancy. If left untreated, it can progress to gestational hypertension, pre-eclampsia, or eclampsia. | **[[Chronic hypertension]]: Chronic hypertension is defined as high blood pressure present before pregnancy or before 20 weeks of pregnancy. If left untreated, it can progress to gestational hypertension, pre-eclampsia, or eclampsia. | ||
**[[Gestational hypertension]]: Untreated gestational hypertension can eventually progress to preeclampsia/eclampsia. | **[[Gestational hypertension]]: Untreated gestational hypertension can eventually progress to preeclampsia/eclampsia. | ||
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**Connective tissue disorders | **Connective tissue disorders | ||
**Systemic lupus erythematous | **Systemic lupus erythematous | ||
*Genetics: Patients whose mother or sister had the condition are at a higher risk.<ref>{{cite journal| author=Chesley LC, Annitto JE, Cosgrove RA |title=The familial factor in toxemia of pregnancy.| journal=Obstet Gynecol 1968;32:303}}</ref> | *'''Genetics:''' Patients whose mother or sister had the condition are at a higher risk.<ref>{{cite journal| author=Chesley LC, Annitto JE, Cosgrove RA |title=The familial factor in toxemia of pregnancy.| journal=Obstet Gynecol 1968;32:303}}</ref> | ||
==References== | ==References== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Eclampsia, like preeclampsia, tends to occur more commonly in first pregnancies and young mothers where it is thought that exposure to paternal antigens still has been low.
Risk factors
- History of pre-eclampsia/eclampsia: Personal history of a similar event in the past or family history is a significant risk factor for recurrence in the next pregnancy. Having pre-eclampsia in one pregnancy is a strong predictor for recurrence of pre-eclampsia in future gestations. The risk for women to develop pre-eclampsia during the second pregnancy is approximately 15% if the first pregnancy was affected by pre-eclampsia and 1.1% for those without a history of pre-eclampsia. The risk during the third pregnancy is approximately 30% for women who have had two previous affected pregnancies and remains 1.1% for those without any history. For women with the first occurrence of pre-eclampsia in their second pregnancy, the risk was 15.9% during the third pregnancy and 29.0% during the fourth when they had developed pre-eclampsia in the previous two pregnancies.[1]
- Nulliparity: The risk for multiparous women without a history of pre-eclampsia was around 1%.[1]
- Primigravida: The risk of pre-eclampsia is 4.1% in the first pregnancy and 1.7% in later pregnancies overall if none of the previous pregnancies have been affected by pre-eclampsia.[1] This association is the core of theory that says that pre-eclampsia is the consequence of a maternal immune reaction against paternal antigens expressed in the placenta which might result in defective trophoblast invasion and subsequent placental dysfunction. The lower risk of pre-eclampsia among multiparous women has been attributed to desensitisation after exposure to paternal antigens in the placenta during previous pregnancies.[2][3] and to smoother trophoblastic invasion after modification of maternal spiral arteries during the first pregnancy.[4] For this reason pre-eclampsia is also known as a disease of primiparity.
- Interpregnancy interval: A long interpregnancy interval is associated with increased risk of preeclampsia, supporting the hypothesis that some factors delaying clinically recognized conception may also be in a causal pathway for preeclampsia.[5]
- Conditions with a large placenta:
- Multiple gestations: The relative risk of preterm preeclampsia in di-chorionic and mono-chorionic twin pregnancies is similar and substantially higher than in singleton pregnancies. In a study, it was found that the incidence of pre-eclampsia in singleton pregnancies was 2.3% compared to 8% in dichorionic(DC) twin pregnancies and 6% in monochorionic(MC) twin pregnancies. Compared to singletons, the relative risk of total pre-eclampsia was 3.5 for DC twins and 2.6 for MC twins.[6]
- Hydatiform mole
- Women with preexisting vascular diseases:
- Chronic hypertension: Chronic hypertension is defined as high blood pressure present before pregnancy or before 20 weeks of pregnancy. If left untreated, it can progress to gestational hypertension, pre-eclampsia, or eclampsia.
- Gestational hypertension: Untreated gestational hypertension can eventually progress to preeclampsia/eclampsia.
- Renal diseases
- Diabetes
- Gestational diabetes
- History of Gestational diabetes
- Obesity
- Preexisting thrombophilias such as:
- Connective tissue disorders
- Systemic lupus erythematous
- Genetics: Patients whose mother or sister had the condition are at a higher risk.[7]
References
- ↑ 1.0 1.1 1.2 Hernández-Díaz S, Toh S, Cnattingius S (2009). "Risk of pre-eclampsia in first and subsequent pregnancies: prospective cohort study". BMJ. 338: b2255. doi:10.1136/bmj.b2255. PMC 3269902. PMID 19541696.
- ↑ Luo ZC, An N, Xu HR, Larante A, Audibert F, Fraser WD (2007). "The effects and mechanisms of primiparity on the risk of pre-eclampsia: a systematic review". Paediatr Perinat Epidemiol. 21 Suppl 1: 36–45. doi:10.1111/j.1365-3016.2007.00836.x. PMID 17593196.
- ↑ Saftlas AF, Levine RJ, Klebanoff MA, Martz KL, Ewell MG, Morris CD; et al. (2003). "Abortion, changed paternity, and risk of preeclampsia in nulliparous women". Am J Epidemiol. 157 (12): 1108–14. doi:10.1093/aje/kwg101. PMID 12796047.
- ↑ Moore MP, Redman CW (1983). "Case-control study of severe pre-eclampsia of early onset". Br Med J (Clin Res Ed). 287 (6392): 580–3. doi:10.1136/bmj.287.6392.580. PMC 1548969. PMID 6411232.
- ↑ Basso O, Weinberg CR, Baird DD, Wilcox AJ, Olsen J, Danish National Birth Cohort (2003). "Subfecundity as a correlate of preeclampsia: a study within the Danish National Birth Cohort". Am J Epidemiol. 157 (3): 195–202. doi:10.1093/aje/kwf194. PMID 12543618.
- ↑ Francisco, C., Wright, D., Benkő, Z., Syngelaki, A. and Nicolaides, K.H. (2017), Hidden high rate of pre-eclampsia in twin compared with a singleton pregnancy. Ultrasound Obstet Gynecol, 50: 88-92. https://doi.org/10.1002/uog.17470
- ↑ Chesley LC, Annitto JE, Cosgrove RA. "The familial factor in toxemia of pregnancy". Obstet Gynecol 1968;32:303.