Eclampsia risk factors
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
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: Hydatiform moles pose a high risk of early-onset preeclampsia if the pregnancy continues with the moles left untreated[7]. Preeclampsia can develop as early as the 2nd trimester in 30–40% of pregnancies with untreated hydatiform moles.[8] [9]
- 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. Development of preeclampsia is the most prevalent complication in pregnancy in women with chronic hypertension[10]. 17% to 25% of women with chronic hypertension develop preeclampsia compared to the general population where the risk is 3-5%.[11] [12] [13]
- Gestational hypertension: Untreated gestational hypertension can eventually progress to preeclampsia/eclampsia. Approximately 15-25% of patients with gestational hypertension will progress to preeclampsia or severe gestational hypertension[14]. The rate of the progression depends on gestational age at the time of diagnosis and the pregnancy outcome is usually good when the diagnosis is made at ≥ 37 weeks of gestation.[15]
- 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.[16]
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
- ↑ Iriyama, T., Wang, G., Yoshikawa, M. et al. Increased LIGHT leading to sFlt-1 elevation underlies the pathogenic link between hydatidiform mole and preeclampsia. Sci Rep 9, 10107 (2019). https://doi.org/10.1038/s41598-019-46660-4https://doi.org/10.1038/s41598-019-46660-4
- ↑ Kohorn, E. I. Molar pregnancy: presentation and diagnosis. Clinical obstetrics and gynecology 27, 181–191 (1984).
- ↑ Soto-Wright, V., Bernstein, M., Goldstein, D. P. & Berkowitz, R. S. The changing clinical presentation of complete molar pregnancy. Obstetrics and gynecology 86, 775–779, https://doi.org/10.1016/0029-7844(95)00268-V (1995)
- ↑ Chronic Hypertension in Pregnancy Ellen W. Seely and MD Jeffrey EckerMD Originally published18 Mar 2014https://doi.org/10.1161/CIRCULATIONAHA.113.003904Circulation. 2014;129:1254–1261 https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.113.003904
- ↑ Sibai BM. Chronic hypertension in pregnancy.Obstet Gynecol. 2002; 100:369–377.
- ↑ Rey E, Couturier A. The prognosis of pregnancy in women with chronic hypertension.Am J Obstet Gynecol. 1994; 171:410–416.
- ↑ McCowan LM, Buist RG, North RA, Gamble G. Perinatal morbidity in chronic hypertension.Br J Obstet Gynaecol. 1996; 103:123–129.
- ↑ Saudan P, Brown MA, Buddle ML, Jones M. Does gestational hypertension become pre-eclampsia? Br J Obstet Gynaecol. 1998 Nov;105(11):1177-84. doi: 10.1111/j.1471-0528.1998.tb09971.x. PMID: 9853766.
- ↑ Obstetrics and Gynecology Gestational Hypertension – Preeclampsia Baha M. Sibai Fadi G. Mirza https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/obstetrics-and-gynecology/gestational-hypertension-preeclampsia/
- ↑ Chesley LC, Annitto JE, Cosgrove RA. "The familial factor in toxemia of pregnancy". Obstet Gynecol 1968;32:303.