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==Overview==
==Overview==
Eclampsia, like preeclampsia, tends to occur more commonly in first pregnancies and young mothers where it  is  thought that exposure to paternal [[antigen]]s still has been low.


==Risk factors==
==Risk factors==

Revision as of 09:21, 13 August 2021

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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
  • Women with preexisting vascular diseases:
  • Genetics: Patients whose mother or sister had the condition are at a higher risk.[7]

References

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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
  7. Chesley LC, Annitto JE, Cosgrove RA. "The familial factor in toxemia of pregnancy". Obstet Gynecol 1968;32:303.

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