PP112. Prediction of preeclampsia based on clinical risk factors: A prospective high-risk cohort study

Abstract

Early recognition of preeclampsia (PE) is crucial for better obstetric care. Clinical risk factors are easier to identify than biochemical markers and may be useful in the prediction of PE. To evaluate which risk factors provide the best prediction for PE in a group at high-risk for developing PE. A prospective cohort study of 100 pregnant women was performed. During the first trimester we included pregnant women who had at least one of the following risk factors for PE: previous history of PE, previous history of HELLP, pre-existing hypertension, diabetes mellitus, multiple pregnancy, obesity or autoimmune diseases. These women were monitored during their pregnancy and their medical data were used to set up a database. We focused on baseline characteristics (parity, maternal age, maternal smoking, ethnic origin, blood pressure at booking, risk factors mentioned above and medication use). Differences between groups were analysed using the Student's t test or the Mann-Whitney U test as applicable. Categorical data were analysed with χ(2) statistics. Subsequently, multivariable logistic regression analysis with a stepwise backward selection procedure of predictors was performed to identify independent risk factors for PE. Of the 100 women 22 (22.0%) developed PE and 13 (13.0%) developed gestational hypertension (GH). More women in the group with progression to PE had a history of PE (50.0% versus 26.2%, p=0.039), while less women had a multiple pregnancy (4.5% versus 27.7%, p=0.023) as compared with the group not progressing to either PE or GH. In the group of GH, no women were using antihypertensive medication while in the group of women not progressing to either PE or GH 32.3% were using antihypertensive medication (p=0.017). Multivariable logistic regression revealed that singleton pregnancy was the only independent predictor of PE (OR 8.04, 95% CI 1.01 - 64.3, p=0.045). In this prospective cohort study we evaluated clinical risk factors for the development of PE in pregnant high-risk women based on obstetric history and comorbidity. We found that a singleton pregnancy was the only independent predictor for PE in this group of high-risk women. The other risk factors for which the women were included were not strong enough to act as a predictor for PE in this relatively small cohort. Nonetheless, it is important to be alert for PE in this group of pregnant women with high-risk for PE, especially because most of them have more than one risk factor.