Change in paternity: a risk factor for preeclampsia in multiparous women?

Tubbergen, P; Lachmeijer, A. M. A.; Althuisius, Sietske M.; Vlak, M.E.J; Geijn, H.P. van; Dekker, Gustaaf A.

doi:10.1016/s0165-0378(99)00040-6

Cited by 96 publications

(59 citation statements)

References 13 publications

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“…13 Several previous studies have suggested that a change in paternity for the second pregnancy increases the risk of preeclampsia, and primipaternity rather than primiparity has been suggested to be a major risk factor. 2,3,16 In our study, women with a change in paternity for the two pregnancies seemed to have a reduced risk of pre-eclampsia in the second pregnancy after controlling for the time interval between deliveries. Our findings suggest that previous results on the impact of changing paternity on pre-eclampsia risk have been confounded by insufficient control for the time interval between the pregnancies.…”

Section: Previous Studiesmentioning

confidence: 45%

Changing paternity and time since last pregnancy; the impact on pre-eclampsia risk. A study of 547 238 women with and without previous pre-eclampsia

Trogstad¹,

Eskild²,

Magnus³

et al. 2001

International Journal of Epidemiology

104

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Pre-eclampsia is currently regarded as a two-stage disorder: The first stage is insufficient implantation of the placenta that may cause reduced perfusion, the second is maternal symptoms such as hypertension and proteinuria, both consequences of endothelial dysfunction. 1 Pre-eclampsia has been found to occur mainly in first pregnancies. A previous normal pregnancy is associated with a reduced risk of pre-eclampsia, but this protection has been assumed to be lost with change of partner. [2][3][4] In women with a history of pre-eclampsia, changing paternity has been described to reduce the risk of recurrency. 5 A reduction in the risk of preeclampsia and pregnancy-induced hypertension has been found with increasing length of sexual cohabitation before conception. Also, women using non-barrier contraceptives have lower risk compared to those using barrier contraceptives. 6,7 Recent evidence points to normal pregnancy as an inflammatory process, inducing changes in peripheral leukocyte activation similar to those of sepsis. 8 The maternal syndrome of pre-eclampsia is described as an excessive, maternal inflammatory response to pregnancy, representing the extreme end of a general response to pregnancy rather than an intrinsically different state of © International Epidemiological Association 2001 Printed in Great BritainChanging paternity and time since last pregnancy; the impact on pre-eclampsia risk. A study of 547 238 women with and without previous pre-eclampsia Lill IS Trogstad, a,b Anne Eskild, a,b Per Magnus, a Sven Ove Samuelsen a,c and Britt-Ingjerd Nesheim bBackground Long time interval between pregnancies has been found to increase the risk of pre-eclampsia in second pregnancy. Our aim was to investigate whether this effect is influenced by a history of pre-eclampsia or a change in paternity.

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Section: Previous Studiesmentioning

confidence: 45%

Changing paternity and time since last pregnancy; the impact on pre-eclampsia risk. A study of 547 238 women with and without previous pre-eclampsia

Trogstad¹,

Eskild²,

Magnus³

et al. 2001

International Journal of Epidemiology

104

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“…Such adaptation may be relatively defective in a first pregnancy but less so in subsequent pregnancies. Furthermore, there may be partner specificity, 7 which strengthens the argument that pre-eclampsia results from a relative failure to induce maternal tolerance of paternal alloantigens. 8 Partners, Coitus, Sperm, and Semen A change of partner seems to restore the risk of preeclampsia to that of primiparity in multigravid women, for example Zhang and Patel 2007.…”

Section: Clinical and Epidemiological Considerationsmentioning

confidence: 65%

REVIEW ARTICLE: Immunology of Pre‐Eclampsia

Redman

Sargent

2010

American J Rep Immunol

612

486

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Citation Redman CWG, Sargent IL. Immunology of Pre‐eclampsia. Am J Reprod Immunol 2010Pre‐eclampsia develops in stages, only the last being the clinical illness. This is generated by a non‐specific, systemic (vascular), inflammatory response, secondary to placental oxidative stress and not by reactivity to fetal alloantigens. However, maternal adaptation to fetal (paternal alloantigens) is crucial in the earlier stages. A pre‐conceptual phase involves maternal tolerization to paternal antigens by seminal plasma. After conception, regulatory T cells, interacting with indoleamine 2,3‐dioxygenase, together with decidual NK cell recognition of fetal HLA‐C on extravillous trophoblast may facilitate placental growth by immunoregulation. Complete failure of this mechanism would cause miscarriage, while partial failure would cause poor placentation and dysfunctional uteroplacental perfusion. The first pregnancy preponderance and partner specificity of pre‐eclampsia can be explained by this model. For the first time, the pathogenesis of pre‐eclampsia can be related to defined immune mechanisms that are appropriate to the fetomaternal frontier. Now, the challenge is to prove the detail.

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“…Although a woman's risk of gestational hypertension is highest during her first pregnancy, the literature indicates that a change of partner between pregnancies may cause the risk to revert towards the same level as a primigravida. 38 Unfortunately, in this study we had no information on change of partners between pregnancies. À1)).…”

Section: Methodological Considerationsmentioning

confidence: 97%

Maternal educational level and risk of gestational hypertension: the Generation R Study

et al. 2008

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We examined whether maternal educational level as an indicator of socioeconomic status is associated with gestational hypertension. We also examined the extent to which the effect of education is mediated by maternal substance use (that is smoking, alcohol consumption and illegal drug use), pre-existing diabetes, anthropometrics (that is height and body mass index (BMI)) and blood pressure at enrolment. This was studied in 3262 Dutch pregnant women participating in the Generation R Study, a population-based cohort study. Level of maternal education was established by questionnaire at enrolment, and categorized into high, mid-high, mid-low and low. Diagnosis of gestational hypertension was retrieved from medical records using standard criteria. Odds ratios (OR) of gestational hypertension for educational levels were calculated, adjusted for potential confounders and additionally adjusted for potential mediators. Adjusted for age and gravidity, women with mid-low (OR: 1.52; 95% CI: 1.02, 2.27) and low education (OR: 1.30; 95% CI: 0.80, 2.12) had a higher risk of gestational hypertension than women with high education. Additional adjustment for substance use, pre-existing diabetes, anthropometrics and blood pressure at enrolment attenuated these ORs to 1.09 (95% CI: 0.70, 1.69) and 0.89 (95% CI: 0.50, 1.58), respectively. These attenuations were largely due to the effects of BMI and blood pressure at enrolment. Women with relatively low educational levels have a higher risk of gestational hypertension, which is largely due to higher BMI and blood pressure levels from early pregnancy. The higher risk of gestational hypertension in these women is probably caused by pre-existing hypertensive tendencies that manifested themselves during pregnancy.

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Change in paternity: a risk factor for preeclampsia in multiparous women?

Cited by 96 publications

References 13 publications

Changing paternity and time since last pregnancy; the impact on pre-eclampsia risk. A study of 547 238 women with and without previous pre-eclampsia

Changing paternity and time since last pregnancy; the impact on pre-eclampsia risk. A study of 547 238 women with and without previous pre-eclampsia

REVIEW ARTICLE: Immunology of Pre‐Eclampsia

Maternal educational level and risk of gestational hypertension: the Generation R Study

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