Abstract
Objectives: To develop a multivariate model for risk factors specific to early onset preeclampsia (EOP) and late onset preeclampsia (LOP) in our entire population (singleton and twin pregnancies). Material and methods: 20 year-observational population-based historical cohort study (2001–2020). All consecutive births delivered at the Centre Hospitalier Universitaire Hospitalier Sud Reunion’s maternity ward. A standardized validated epidemiological perinatal database was used. Results: During the 20-year period, there were 81,834 pregnancies and 83,497 infants born, 1232 dichorionic and 350 monochorionic twin pregnancies. There were 2120 cases of preeclampsia, of which 2001 were preeclamptic singleton pregnancies and 119 twin pregnancies (incidence 7.5% in twin pregnancies vs. 2.5% singletons, OR 3.0, p < 0.001). Independent risk factors for EOP and LOP in a multivariate model (controlling for the two major confounders: maternal ages—both risks for EOP and LOP, and maternal pre-pregnancy BMI—specific risk factor for LOP) were: history of preeclampsia (adjusted OR (aOR) 11.7 for EOP, 7.8 for LOP, p < 0.0001), chronic hypertension (aOR 7.3 for EOP, 3.9 for LOP, p < 0.0001), history of perinatal death (aOR 2.2 for EOP, p < 0.0001 and 1.48 for LOP, p = 0.007), primipaternity (aOR 3.0 for EOP and 3.6 for LOP, p = 0.001), dizygotic twin pregnancies (aOR 3.7 for EOP, p < 0.0001 and 2.1 for LOP, p = 0.003), monozygotic twin pregnancies (aOR 3.98 for EOP, p = 0.003 and non-significant (NS) for LOP), ovulation induction (aOR 5.6 for EOP, p = 0.004 and NS for LOP), and in vitro fertilization (aOR 2.8 for EOP, p = 0.05 and NS for LOP). Specific to LOP and NS for EOP: renal diseases (aOR for LOP 2.9, p = 0.007) and gestational diabetes mellitus (aOR 1.2, p = 0.04). Conclusions: Maternal ages over 35 years, chronic hypertension, history of preeclampsia, ovulation induction, in vitro fertilizations, history of perinatal deaths and twin pregnancy (in our experience, especially mono zygotic twin pregnancies) are significant risk factors for EOP. New paternity is an independent factor for both EOP and LOP.
Highlights
In Reunion island we have a very high incidence of early onset preeclampsia EOP (31%of our preeclampsia cases, PE) [1,2,3], which is surprising as compared with international literature [1], where EOP cases has rather proportion of 10%
Our study confirms that the major risk factors for EOP are chronic hypertension, hisOur study confirms that the major risk factors for EOP are chronic hypertension, history of preeclampsia, ovulation induction, history of perinatal deaths and twin pregnantory of preeclampsia, ovulation induction, history of perinatal deaths and twin pregnancies
It seems that an international consensus is comReading the international literature, it seems that an international consensus is comprised prised of 11 risk factors: multiple pregnancies, chronic hypertension, preeclampsia or hyof 11 risk factors: multiple pregnancies, chronic hypertension, preeclampsia or hypertenpertension in a previous pregnancy, diabetes, nulliparity, renal disease, “Thrombophilsion in a previous pregnancy, diabetes, nulliparity, renal disease, “Thrombophilias”-anti2 ias”-anti phospholipid syndrome, maternal age >40 years, body mass index >35 kg/m, phospholipid syndrome, maternal age > 40 years, body mass index > 35 kg/m2, family hisfamily history of preeclampsia, assisted reproduction [12,13,14,15,16]
Summary
In Reunion island we have a very high incidence of early onset preeclampsia EOP (31%of our preeclampsia cases, PE) [1,2,3], which is surprising as compared with international literature [1], where EOP cases has rather proportion of 10%. Over the last five years we published six epidemiological studies analyzing risk factors for EOP and LOP (five on singleton pregnancies [4,5,6,7,8] and the last one analyzing twin pregnancies [9]). The first study [4] revealed that EOP women were older than LOP ones; while primigravidas and primiparas, typically younger than multiparous women, were more prone to develop LOP, findings confirmed by a study we shared with the University Maternity of Antananarivo, Madagascar [10]. The second study [5] concluded that chronic hypertension and history of preeclampsia were the strongest risk factors for EOP. The third study [6] tested whether it was not the international cut-off of 34 weeks between EOP and LOP that could explain our previous results.
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