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Objective Design Setting SubjectsTo study associations between established risk factors for pre-eclampsia and different clinical manifestations of the disease.A population-based, nested case-control study.Information from 12,804 consecutive deliveries that took place over three years at a birth clinic, which alone serves a population of nearly 240,000 in Rogaland county, Norway.Cases of pre-eclampsia (n = 323) and healthy controls (n = 650) were selected. Pre-eclampsia was defined as increase in diastolic blood pressure (2 25 mmHg to 2 90 mmHg) and proteinuria (2 1+ by dipstick testing) after 20 weeks of pregnancy.Main study measures Parity, previous pre-eclampsia, blood pressure, maternal weight, and maternal smoking were included as study variables. Women with pre-eclampsia were grouped according to clinical manifestations of the disease (i.e. severity [mild, moderate or severe]) and time of onset (early or late gestation). Associations with the study factors were estimated as relative risks (odds ratio, OR).Both nulliparity and hypertension increased pre-eclampsia risk, with no clear preference for any clinical subtype. High maternal weight was related to a higher risk of mild and moderate, but not severe, pre-eclampsia. Previous pre-eclampsia strongly increased the risk for pre-eclampsia in the current pregnancy, and the risk of early onset disease was especially high (OR 42.4; 95% CI 11.9-151.6). Overall, smoking was associated with a reduced risk for pre-eclampsia (OR 0.6; 95% CI 0.4-0.9). However, no effect of smoking was observed in the early onset disease group and among women with repeated pre-eclampsia. ConclusionNulliparity and hypertension increased the risk for each subgroup of pre-eclampsia, but high maternal weight, previous pre-eclampsia and smoking were not consistently associated with each clinical subtype. This observation may suggest that heterogeneous clinical manifestations of pre-eclampsia may be preceded by different pathological mechanisms.

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Levels of IGF-I and leptin in umbilical cord plasma were higher in girls than in boys, but in both sexes, these 2 factors contributed independently and positively to birth weight and length. For IGFBP-1, high levels were associated with low birth weight and reduced length. If intrauterine growth is related to the risk of developing adult diseases, IGF-I, IGFBP-1, and leptin may be involved in the underlying processes.1131-1135 insulin like growth factors, leptin, umbilical cord plasma, birth weight.

Birth length is perhaps a better predictor of adult height and weight than birth weight, and should be considered as a possible risk factor for adult morbidity and mortality.