Prediction and Prevention of Recurrent Preeclampsia

Abstract

Women with a history of previous preeclampsia are at increased risk of preeclampsia and other adverse pregnancy outcomes in subsequent pregnancies. The magnitude of this risk is dependent on gestational age at time of disease onset, severity of disease, and presence or absence of preexisting medical disorders. The objective in the management of these patients is to reduce risk factors by optimizing maternal health before conception and to detect obstetric complications as early as possible. This objective can be achieved by formulating a rational approach that includes preconception evaluation and counseling, early antenatal care, frequent monitoring of maternal and fetal well-being, and timely delivery. First-trimester ultrasound examination is essential for accurate dating and establishing fetal number. Laboratory studies are obtained to assess the function of different organ systems that are likely to be affected by preeclampsia and to establish a baseline for future assessment. Recent studies have confirmed that there is no single biomarker that can be clinically useful for the prediction of recurrent preeclampsia. Combinations of biomarkers and biophysical parameters appear promising, but more data are needed to confirm their use in clinical practice. Supplementation with fish oil, calcium, or vitamin C and E and the use of antihypertensives have been shown to be ineffective in the prevention of recurrent preeclampsia and are not recommended. Supplementation with low-dose aspirin may be offered on an individualized basis. Because women with previous preeclampsia are at increased risk for adverse pregnancy outcomes (preterm delivery, fetal growth restriction, abruptio placentae, and fetal death) in subsequent pregnancies, we recommend more frequent monitoring for signs and symptoms of severe hypertension or preeclampsia than that recommended for normal pregnancy. This monitoring may include more frequent prenatal visits, home blood pressure monitoring, or nursing contacts. For patients with a prior pregnancy complicated by preeclampsia with fetal growth restriction, we recommend serial ultrasound evaluation of fetal growth and amniotic fluid volume. The development of severe gestational hypertension, fetal growth restriction, or recurrent preeclampsia requires maternal hospitalization.

Risk Factors for Pre-eclampsia in Multiparous Women in Lagos, Nigeria

“…Maternal age below 30 years appeared to be protective in this study. This finding correlates with other similar studies 2,7 . Maternal level of education was found to have no significant relationship to the development of pre-eclampsia just like previous studies where the level of education was not found to be a significant risk factor 12,25 .…”

“…It is a disorder characterized by vasoconstriction, metabolic changes, endothelial dysfunction, and activation of the coagulation cascade in conjunction with an inflammatory response 4 . Pre-eclampsia complicates 3-5% of first pregnancies and 1% of subsequent pregnancies with around 5-10% of cases being severe 2 . In Nigeria, a prevalence rate of 5.6% has been reported 5 .…”

“…Pre-eclampsia is one of the most important causes of maternal and perinatal mortality and morbidity in both developing and developed countries 1,2 . Pre-eclampsia is a multi-systemic disorder that is usually associated with elevated blood pressure and proteinuria.…”

Folate Metabolism and Preeclampsia

“…Accordingly, these findings support an expected beneficial effect of antioxidant therapy in the prevention of PE and other pregnancy-related disorders 61 . Numerous studies have been carried out to investigate prophylactic and/or therapeutic prevention of oxidative stress and the impact on PE and its perinatal complications 62. Despite the logic behind using antioxidant vitamins, several studies show that Vitamin C/E supplementation is of no benefit and may in fact cause harm 63 .…”

New Developments in the Pathogenesis of Preeclampsia

“…Other factors include a partner who fathered preeclamptic pregnancy with another woman, woman born as small for gestational age, and adverse outcomes in a previous pregnancy 7 . Women with a history of preeclampsia also develop cardiovascular disease later in their life.…”