Clinical risk factors for Preeclampsia in the 21st century

Emmanuelle Pare, Samuel Parry, Thomas F. McElrath, Dominick Pucci, Amy Newton, Kee Hak Lim

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

OBJECTIVE: We sought to validate several clinical risk factors previously described for preeclampsia in a large contemporary multicenter prospective cohort.

METHODS: We enrolled women from three sites before 15 weeks of gestation. Demographic and clinical risk factors were collected through standardized chart review. The main outcome of preeclampsia was diagnosed using the American College of Obstetricians and Gynecologists definitions from 2002. Multivariable logistic regression was used to control for confounders.

RESULTS: Two thousand six hundred thirty-seven women are included in this analysis; 237 (9.0%) developed preeclampsia. In adjusted analysis, chronic hypertension (adjusted odds ratio [OR] 2.72; 95% confidence interval 1.78-4.13), pregestational diabetes (adjusted OR 3.88; 2.08-7.26), multiple gestation (adjusted OR 2.96; 1.74-5.03), African American race (adjusted OR 1.91; 1.35-2.71), prior preeclampsia (adjusted OR 3.63; 2.29-5.73), nulliparity (adjusted OR 1.73; 1.26-2.38), assisted reproductive techniques (adjusted OR: 1.72; 1.10-2.68), and being overweight (adjusted OR for body mass index [BMI, kg/m2] greater than 25-30: 1.65; 1.13-2.41) or obese (adjusted OR for BMI greater than 30-35: 2.34, 1.51-3.61; adjusted OR for BMI greater than 35-40: 3.59, 2.13-6.03; adjusted OR for BMI greater than 40: 6.04, 3.56-10.24) were associated with preeclampsia, but advanced maternal age was not. Similar associations were found for severe preeclampsia. A dose-response effect was observed in the relationship between BMI and both preeclampsia and severe preeclampsia. Being overweight or obese was the most important risk factor for both preeclampsia and severe preeclampsia with an attributable risk percent of 64.9% and 64.4%, respectively.

CONCLUSION: In this contemporary cohort, increasingly prevalent and potentially modifiable factors were confirmed as significant risk factors for preeclampsia and severe preeclampsia, the most important being overweight or obese. This information is important to guide public health efforts in preeclampsia prevention.

Original languageEnglish (US)
Pages (from-to)763-770
Number of pages8
JournalObstetrics and Gynecology
Volume124
Issue number4
DOIs
StatePublished - Oct 10 2014
Externally publishedYes

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Pre-Eclampsia
Odds Ratio
Pregnancy
Assisted Reproductive Techniques
Maternal Age
Parity
African Americans
Body Mass Index
Public Health
Logistic Models
Demography
Confidence Intervals
Hypertension

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Medicine(all)

Cite this

Pare, E., Parry, S., McElrath, T. F., Pucci, D., Newton, A., & Lim, K. H. (2014). Clinical risk factors for Preeclampsia in the 21st century. Obstetrics and Gynecology, 124(4), 763-770. https://doi.org/10.1097/AOG.0000000000000451

Clinical risk factors for Preeclampsia in the 21st century. / Pare, Emmanuelle; Parry, Samuel; McElrath, Thomas F.; Pucci, Dominick; Newton, Amy; Lim, Kee Hak.

In: Obstetrics and Gynecology, Vol. 124, No. 4, 10.10.2014, p. 763-770.

Research output: Contribution to journalArticle

Pare, E, Parry, S, McElrath, TF, Pucci, D, Newton, A & Lim, KH 2014, 'Clinical risk factors for Preeclampsia in the 21st century', Obstetrics and Gynecology, vol. 124, no. 4, pp. 763-770. https://doi.org/10.1097/AOG.0000000000000451
Pare, Emmanuelle ; Parry, Samuel ; McElrath, Thomas F. ; Pucci, Dominick ; Newton, Amy ; Lim, Kee Hak. / Clinical risk factors for Preeclampsia in the 21st century. In: Obstetrics and Gynecology. 2014 ; Vol. 124, No. 4. pp. 763-770.
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N2 - OBJECTIVE: We sought to validate several clinical risk factors previously described for preeclampsia in a large contemporary multicenter prospective cohort.METHODS: We enrolled women from three sites before 15 weeks of gestation. Demographic and clinical risk factors were collected through standardized chart review. The main outcome of preeclampsia was diagnosed using the American College of Obstetricians and Gynecologists definitions from 2002. Multivariable logistic regression was used to control for confounders.RESULTS: Two thousand six hundred thirty-seven women are included in this analysis; 237 (9.0%) developed preeclampsia. In adjusted analysis, chronic hypertension (adjusted odds ratio [OR] 2.72; 95% confidence interval 1.78-4.13), pregestational diabetes (adjusted OR 3.88; 2.08-7.26), multiple gestation (adjusted OR 2.96; 1.74-5.03), African American race (adjusted OR 1.91; 1.35-2.71), prior preeclampsia (adjusted OR 3.63; 2.29-5.73), nulliparity (adjusted OR 1.73; 1.26-2.38), assisted reproductive techniques (adjusted OR: 1.72; 1.10-2.68), and being overweight (adjusted OR for body mass index [BMI, kg/m2] greater than 25-30: 1.65; 1.13-2.41) or obese (adjusted OR for BMI greater than 30-35: 2.34, 1.51-3.61; adjusted OR for BMI greater than 35-40: 3.59, 2.13-6.03; adjusted OR for BMI greater than 40: 6.04, 3.56-10.24) were associated with preeclampsia, but advanced maternal age was not. Similar associations were found for severe preeclampsia. A dose-response effect was observed in the relationship between BMI and both preeclampsia and severe preeclampsia. Being overweight or obese was the most important risk factor for both preeclampsia and severe preeclampsia with an attributable risk percent of 64.9% and 64.4%, respectively.CONCLUSION: In this contemporary cohort, increasingly prevalent and potentially modifiable factors were confirmed as significant risk factors for preeclampsia and severe preeclampsia, the most important being overweight or obese. This information is important to guide public health efforts in preeclampsia prevention.

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