Clinical factors associated with preeclampsia recurrence

Preeclampsia, defined as a diagnosis of hypertension and proteinuria after 20 gestational weeks, complicates up to 10% of pregnancies [1], [2], and is a major cause of perinatal maternal mortality [3]. Preeclampsia is also associated with immediate and long term offspring and maternal morbidities, including newborn low Apgar scores and sepsis, and maternal cardiovascular morbidities and mortality [4], [5], [6], [7], [8]. These increased risks are dependent upon many factors including: the severity of the preeclampsia, gestational age at onset, maternal background health, socio-economic status and ethnicity. Due to common etiology, women with a history of preeclampsia are at increased risk for pregnancy complications in current and subsequent pregnancy, including preterm delivery, gestational diabetes and fetal growth restriction [9], [10].

Some of the risk factors for preeclampsia include nulliparity, old maternal age, lifestyle characteristics, family or personal history of preeclampsia [11], [12], [13], [14].

Recurrent preeclampsia occurs in 10-15% of pregnancies, although higher rates have also been reported [10], [15]. The fact that preeclampsia tends to reoccur in some women and in the same families, suggests maternal chronic characteristics, such as persistent environmental exposures or genetic factors are associated with preeclampsia and its recurrence [16], [17], [18], [19]. Although recurrent preeclampsia may present during the subsequent pregnancy with less clinical manifestations [20], women with recurrent preeclampsia are at increased risk for long-term morbidities, as compared to women with a single preeclampsia [20], [21].

Identifying early markers of preeclampsia before the clinical manifestations is a great challenge [22], since it may enable applying prevention strategies to minimize major maternal and offspring complications. Several methods for first trimester screening are proposed [23], but currently there are no effective screening test commonly used for early detection of preeclampsia.

Prevention and treatment options for preeclampsia or recurrent preeclampsia have been practiced and studied, including aspirin administration and vitamin D supplementation [12], [24], [25], [26]. Both prevention and treatment options are depended on the severity of the clinical manifestation and background maternal characteristics.

Although extensive research on treatment and prevention strategies, rates of preeclampsia and recurrent preeclampsia have not decreased over the last 2 decades [15]. This may be due to the increase in incidence of preeclampsia risk factors, such as diabetes mellitus, obesity and chronic hypertension [27]. Some recurrent preeclampsia risk factors, such as obesity, are preventable and background co-morbidities can be treated. Since treatment is recommended from early pregnancy before preeclampsia onset, and since recurrent preeclampsia entails an even higher risk for maternal morbidities, it is of major importance to identify women at risk for recurrent preeclampsia. The aim of the current study was to identify first pregnancy characteristics which are associated with recurrent preeclampsia in subsequent pregnancy.

留言 (0)

沒有登入
gif