Case-control study of severe pre-eclampsia of early onset.

Abstract

Twenty four women with severe pre-eclampsia diagnosed before 34 weeks' gestation were compared with 48 randomly selected controls matched for age and parity. Subjects were studied in the puerperium using a questionnaire, clinical examination, and review of case records. A history of infertility, headaches (particularly migraine), pre-eclampsia in a previous pregnancy, or a raised serum a-fetoprotein concentration at the time of screenri ing for neural tube defect in the index pregnancy were all identified as significant risk factors in the pre-eclamptic women. Maternal age, a history of chronic hypertension or renal disease, or excessive maternal weight were not significantly associated with pre-eclampsia. Almost all the infants of pre-eclamptic women showed retarded growth: 18 were below the 10th centile and only one weighed more than the 25th centile. Four babies died.These observations indicate that pre-eclampsia of early onset may differ from the late onset disease not only in its very high perinatal morbidity and mortality but in its distinctive maternal risk factors.

Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies

“…Women with pre-eclampsia in their second pregnancy are also more than seven times more likely to have a history of pre-eclampsia in their first pregnancy than women in their second pregnancy who do not develop pre-eclampsia (7.61, 4.3 to 13.47) (seven case-control studies15 16 18 19 24 – 26). …”

Headache and Pregnancy

“…75 In a case-control study, women diagnosed with preeclampsia were more likely to have had a previous history of headaches when compared with controls (54% in preeclamptic women vs. 17% in uncomplicated pregnancies). 76 Severe headaches, defined as headaches associated with nausea, vomiting, or visual symptoms, were also more common in women with preeclampsia versus controls (33% vs. 6%). 76 In a prospective study, 485 pregnant Headache and Pregnancy women with prepregnancy migraines were followed throughout pregnancy and had a 10-fold increased incidence of preeclampsia compared with the general population.…”

“…76 Severe headaches, defined as headaches associated with nausea, vomiting, or visual symptoms, were also more common in women with preeclampsia versus controls (33% vs. 6%). 76 In a prospective study, 485 pregnant Headache and Pregnancy women with prepregnancy migraines were followed throughout pregnancy and had a 10-fold increased incidence of preeclampsia compared with the general population. 58 The exact relationship between migraine and preeclampsia is uncertain.…”

“…Although the mechanisms are not fully understood, there seems to be an association between a history of migraine and an increased risk of preeclampsia during pregnancy. [73][74][75][76] Various features of headaches have been associated with preeclampsia/eclampsia, such as worsening headache during pregnancy. 75 In a case-control study, women diagnosed with preeclampsia were more likely to have had a previous history of headaches when compared with controls (54% in preeclamptic women vs. 17% in uncomplicated pregnancies).…”

The Management of Hypertension in Pregnancy

“…These include obstruction of the spiral arteries by sacute athero&<<, (27) which in turn may cause placental infarcts (28). In addition, both fetus and placenta tend to be small for gestational age particularly in early-onset (29) and proteinuric (30) preeclampsi. If the placental circulation is unable to autoregulate flow with changes in perfusing pressure then,given these structural changes, the treatment of pre-eclamptic hypertension must diminish placental perfusion further.…”