Epidemiology of pre-eclampsia and the other hypertensive disorders of pregnancy.

Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada.
Best practice & research. Clinical obstetrics & gynaecology (Impact Factor: 1.87). 02/2011; 25(4):391-403. DOI: 10.1016/j.bpobgyn.2011.01.006
Source: PubMed

ABSTRACT Hypertensive disorders of pregnancy include chronic hypertension, gestational hypertension, pre-eclampsia and chronic hypertension with superimposed pre-eclampsia. Pre-eclampsia complicates about 3% of pregnancies, and all hypertensive disorders affect about five to 10% of pregnancies. Secular increases in chronic hypertension, gestational hypertension and pre-eclampsia have occurred as a result of changes in maternal characteristics (such as maternal age and pre-pregnancy weight), whereas declines in eclampsia have followed widespread antenatal care and use of prophylactic treatments (such as magnesium sulphate). Determinants of pre-eclampsia rates include a bewildering array of risk and protective factors, including familial factors, sperm exposure, maternal smoking, pre-existing medical conditions (such as hypertension, diabetes mellitus and anti-phospholipid syndrome), and miscellaneous ones such as plurality, older maternal age and obesity. Hypertensive disorders are associated with higher rates of maternal, fetal and infant mortality, and severe morbidity, especially in cases of severe pre-eclampsia, eclampsia and haemolysis, elevated liver enzymes and low platelets syndrome.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Even in developed countries, severe specific pregnancy complications may occur in the immediate postpartum period and require admission to the ICU. The characteristics and risk factors of acute renal failure (ARF) induced by these complications and their treatments are not well known. We performed a retrospective multicenter study in three intensive care departments linked to level III maternity wards in the north of France. All patients admitted to ICU for postpartum complications over a 5-year period (2008 to 2012) were included. Clinical and biological data, delivery characteristics, type of complications, and treatments were compared by univariate and multivariate analyses according to the occurrence and severity of ARF. One hundred eighty-two patients admitted to ICU for postpartum complications were included in the study. Sixty-eight patients (37%) developed an ARF: 49 with a low or medium severity and 19 with a severe ARF requiring renal replacement therapy. Hemolysis, elevated liver enzyme, and low platelet count (HELLP) syndrome on its own (p = 0.047) or combined with postpartum haemorrhage (p = 0.003), previous treatment by hyperoncotic albumin infusion (p = 0.001) and blockade of fibrinolysis by tranexamic acid (p = 0.03), was associated with secondary ARF. By multivariate analysis, the only independent factors were the association of HELLP syndrome with postpartum haemorrhage and the use of hyperoncotic albumin infusion. HELLP syndrome associated with postpartum haemorrhage induces a high risk of ARF in the complicated postpartum setting. A particular attention should be given to treatments that could worsen the kidney function in that situation.
    Annals of intensive care. 01/2014; 4:36.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Pre-eclampsia is a multi-system condition in pregnancy that is characterised by the onset of hypertension and proteinuria in women after the 20th week and it remains a leading cause of maternal and fetal mortality. Despite this the causative molecular basis of pre-eclampsia remains poorly understood. As a result, an intensive research effort has focused on understanding the molecular mechanisms involved in pre-eclampsia and using this information to identify new pre-symptomatic bio-markers of the condition. Activin A and its receptor, ACVR2A, have been extensively studied in this regard. Activin A is a member of the transforming growth factor (TGF)-β superfamily that has a wide range of biological functions depending on the cellular context. Recent work has shown that polymorphisms in ACVR2A may be a genetic risk factor for pre-eclampsia. Furthermore, both placenta and serum levels of Activin A are significantly increased in pre-eclampsia suggesting that Activin A may be a possible biomarker for the condition. Here we review the latest advances in this field and link these with new molecular data that suggest that the oxidative stress and pro-inflammatory cytokine production seen in pre-eclampsia may result in increased placental Activin A secretion in an attempt to maintain placental function. Copyright © 2014 Elsevier Ltd. All rights reserved.
    Cytokine 02/2015; 71(2). · 2.87 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To compare the risk factors as well as maternal and perinatal outcomes between women with eclampsia to those with mild and severe preeclampsia.MethodsA retrospective study comparing pregnancy outcomes of women with preeclampsia (mild and severe) with those who were complicated with eclampsia was conducted. Statistical analysis included chi-square test for trend (the linear-by-linear association test).ResultsThe study population consisted of 10,018 women, 0.5% (n = 52) suffered from eclampsia, 24% (n = 2,409) had severe preeclampsia and 75.4% (n = 7,557) had mild preeclampsia. A significant linear association was noted between the three groups (eclampsia, severe preeclampsia and mild preeclampsia) and risk factors such as nulliparity, young maternal age and oligohydramnios. A significant linear association was also documented between the three groups and adverse obstetric and perinatal outcomes such as post-partum hemorrhage, the need for blood transfusion, non reassuring fetal heart rate (NRFHR) patterns, low Apgar score at 5 min and perinatal mortality.Conclusions An unfavorable slope was noted in the rate of certain risk factors and adverse perinatal outcomes between women with eclampsia through patients with severe preeclampsia to those with mild preeclampsia.
    Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health. 04/2013; 3(2):146-150.


Available from
Jun 2, 2014