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: 1.92). 02/2011; 25(4):391-403. DOI: 10.1016/j.bpobgyn.2011.01.006
Source: PubMed


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.

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    • "Preeclampsia is a multi-system disorder characterized by hypertension and proteinuria in the last half of pregnancy [1] [2]. Preclampsia complicates 5% of all pregnancies , and its life threatening manifestations make it a major cause of maternal and prenatal morbidity and mortality world wide, hence there is a critical need for strategies to predict, prevent and improve management of this disorder [3]. "
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    ABSTRACT: Abstract Background: Hyperhomocysteinemia appears to cause endothelial dysfunction through direct toxic and oxidative stress mechanisms. was found to be seven times more common in women with history of severe preeclampsia. Objective: The aim of this study was to determine the effect of folic acid administration on the maternal serum homocysteine level in mild and severe pre-eclamptic cases between 28 and 32 weeks of gestation. Setting: The study was conducted on forty pre-eclamptic patients recruited from Elshatby Maternity University Hospital, Alexandria, Egypt over year 2012. Study design: The cases were subdivided into two groups; 20 mild and 20 severe pre-eclamptic cases. Each group was subdivided into two subgroups • Ten cases will take folic acid 5mg daily from 28 to 32 weeks. • Ten control cases (no folic acid administration). Results: The present study found that plasma homocysteine level was lowered after folic acid administration for both mild and severe cases. In the control group who did not receive folic acid, they had high homocysteine level . Conclusion: folic acid can be administrated till the second trimester of pregnancy to decrease the risk of preeclampsia.
    Full-text · Article · Sep 2015
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    • "Preeclampsia (PE) is a hypertensive complication that occurs in approximately 3% of all pregnancies and may lead to poor pregnancy outcomes of both mother and fetus [1] [2]. It is thought that in women with PE a complex interaction between placental factors, maternal constitutional factors, and pregnancy-specific vascular and immunological adaptation occurs already in the first trimester of their pregnancy [3] [4] [5]. "
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    ABSTRACT: Objective: To expand the search for preeclampsia (PE) metabolomics biomarkers through the analysis of acylcarnitines in first-trimester maternal serum. Methods: This was a nested case-control study using serum from pregnant women, drawn between 8 and 14 weeks of gestational age. Metabolites were measured using an UPLC-MS/MS based method. Concentrations were compared between controls (n = 500) and early-onset- (EO-) PE (n = 68) or late-onset- (LO-) PE (n = 99) women. Metabolites with a false discovery rate <10% for both EO-PE and LO-PE were selected and added to prediction models based on maternal characteristics (MC), mean arterial pressure (MAP), and previously established biomarkers (PAPPA, PLGF, and taurine). Results: Twelve metabolites were significantly different between EO-PE women and controls, with effect levels between -18% and 29%. For LO-PE, 11 metabolites were significantly different with effect sizes between -8% and 24%. Nine metabolites were significantly different for both comparisons. The best prediction model for EO-PE consisted of MC, MAP, PAPPA, PLGF, taurine, and stearoylcarnitine (AUC = 0.784). The best prediction model for LO-PE consisted of MC, MAP, PAPPA, PLGF, and stearoylcarnitine (AUC = 0.700). Conclusion: This study identified stearoylcarnitine as a novel metabolomics biomarker for EO-PE and LO-PE. Nevertheless, metabolomics-based assays for predicting PE are not yet suitable for clinical implementation.
    Full-text · Article · Jul 2015 · Disease markers
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    • "At the time of publication, we will be five of seven years into the initiative. We believe that pre-eclampsia matters because it remains a leading cause of maternal and perinatal morbidity and mortality worldwide [3] [4]. However, in parallel with our current focus on pregnancy hypertension, we are convinced that the time has come to look beyond single clinical entities (e.g. "
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    ABSTRACT: While we believe that pre-eclampsia matters - because it remains a leading cause of maternal and perinatal morbidity and mortality worldwide - we are convinced that the time has come to look beyond single clinical entities (e.g. pre-eclampsia, postpartum hemorrhage, obstetric sepsis) and to look for an integrated approach that will provide evidence-based personalized care to women wherever they encounter the health system. Accurate outcome prediction models are a powerful way to identify individuals at incrementally increased (and decreased) risks associated with a given condition. Integrating models with decision algorithms into mobile health (mHealth) applications could support community and first level facility healthcare providers to identify those women, fetuses, and newborns most at need of facility-based care, and to initiate lifesaving interventions in their communities prior to transportation. In our opinion, this offers the greatest opportunity to provide distributed individualized care at scale, and soon.
    Full-text · Article · Feb 2015 · International Journal of Gynecology & Obstetrics
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