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

Abstract

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.

Socio-Demographic and Other Risk Factors of Pre Eclampsia at a Tertiary Care Hospital, Karnataka: Case Control Study

“…In a similar study done in Nigeria [27] long birth interval of more than sixty months was associated with seven fold risk of developing pre-eclampsia. The reason for prolonged birth interval and pre -eclampsia was not quite clear but prolonged period could be due to factors such as change of paternity and possibly sub fecundity, which predispose to pre -eclampsia [28]. It remains too studied if this association is simply because women who conceive early in marriage are usually nulliparous, which is an independent risk factor [29].…”

RETIRED: Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy

“…Higher BMI in prior preeclampsia increases the recurrence risk [185]. The following traditional preeclampsia risk markers for first occurrence do not influence recurrence: multiple gestation, change of partner, and long interpregnancy interval) [179,184,[197][198][199].…”

Recurrence risk of preeclampsia in twin and singleton pregnancies

“…Known risk factors for preeclampsia that have been identified previously in this study population have been controlled for [Trogstad et al, 2001]. We had no access to information on maternal weight, social class or education.…”

“…Changed paternity has been considered a significant risk factor for preeclampsia in multiparas, and this could be explained by a fetal genotypic influence [Roberts and Cooper, 2001]. However, recent studies question the primipaternity theory of preeclampsia, since the increased risk in women who change partners seems to disappear when controlling for the time interval since last birth [Basso et al, 2001;Trogstad et al, 2001]. Recently, reports on monozygotic twins that are concordant for preeclampsia have also been published [Dekker and Sibai, 1999;O'Shaughnessy et al, 2000].…”