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The risk of pre-eclampsia.

The risk of a woman having pre-eclampsia in her first pregnancy is greater than in subsequent pregnancies. This is accepted information, but what are the modern data on subsequent pregnancies in woman who did--or did not--have pre-eclampsia the first time around?

Hernandez Diaz et al. from Sweden now provide the odds for their countrywomen in their first and in their next gestations (BMJ 2009; 338: b2255).

* Of 764 000 women, 4% had pre-eclampsia in their first pregnancy.

* Of these 4, 15% had pre-eclampsia again in their second pregnancy.

* Of the 96% who did not have pre-eclampsia, only 1% had pre-eclampsia in their second pregnancy.

* If a woman had pre-eclampsia in her second pregnancy only, then her risk is 15% for her third pregnancy.

* If a woman had pre-eclampsia in her first and second pregnancies, her risk rises to 30% for her third pregnancy.

* If a woman had no pre-eclampsia in her first or second pregnancies, her risk is 1% for her third pregnancy.

Recurrence rates were higher for women having pre-eclampsia associated with deliveries before 34 weeks' gestation than for those having pre-eclampsia with a longer gestation, suggesting two distinct conditions: 'a severe recurrent early-onset type affected by chronic factors, genetic or environmental, and a milder sporadic form affected by transient factors'.

Another study from Scandinavia, this time Denmark, links other pregnancy complications to their reappearance in a second pregnancy (Lykke et al., Obstet Gynecol 2009; 113: 1217-1224). Preterm delivery, growth restriction and pre-eclampsia all showed a pre-disposition to recurrence, and the data echoed a 'dose-response relationship' with early onset indicating a greater subsequent risk.
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Title Annotation:THE BEST OF THE REST
Author:Kent, Athol
Publication:South African Journal of Obstetrics and Gynaecology
Article Type:Brief article
Geographic Code:6SOUT
Date:Oct 1, 2009
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