The blurring boundaries between placental and maternal preeclampsia: a critical appraisal of 1800 consecutive preeclamptic cases

• Published in: The journal of maternal-fetal & neonatal medicine Vol. 35; no. 13; pp. 2450 - 2456
• Main Authors: Robillard, Pierre-Yves, Dekker, Gustaaf, Scioscia, Marco, Bonsante, Francesco, Iacobelli, Silvia, Boukerrou, Malik, Hulsey, Thomas C.
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 03-07-2022
• Subjects: body mass index; Cohort Studies; early onset preeclampsia; epidemiology; Female; Gestational Age; Humans; late onset preeclampsia; Placenta; Pre-Eclampsia - epidemiology; Preeclampsia; Pregnancy; Pregnancy Complications; epidemiology; early onset preeclampsia; late onset preeclampsia; Preeclampsia; body mass index
• ISSN: 1476-7058; 1476-4954
• DOI: 10.1080/14767058.2020.1786516

To present a comprehensive overview of different risk factors for early onset preeclampsia (<34 weeks gestation, EOP) vs. late onset (LOP).
South-Reunion University's maternity (Reunion Island, Indian Ocean). 18.5 year-observational population-based cohort study (2001-2019). Epidemiological perinatal database with information on obstetrical and neonatal risk factors. All consecutive singleton pregnancies (>21 weeks) compared with all preeclamptic pregnancies delivered in the south of Reunion island.
Comparing risk factors between EOP and LOP.
Among 1814 singleton preeclamptic pregnancies (600 EOP and 1214 LOP), EOP women were older than LOP 29.5 vs. 28.6 years, p = .009, primigravidas (OR 0.78 [0.63-0.96], p = .02) were prone to LOP. History of preeclampsia (PE) (aOR 12.8 vs. 7.1), chronic hypertension (aOR 6.5 vs. 4.5) had much higher adjusted odds ratios for EOP than for LOP, p < .001. Specific to EOP: coagulopathies (aOR 2.95, p = .04), stimulated pregnancies (aOR 3.9, p = .02). Specific to LOP: renal diseases (aOR 2.0, p = .05) and protective effect for smoking (aOR 0.75, p = .008). EOP women were prone to have a lower BMI.
"Placental preeclampsia" (defective placentation) being linked to early onset PE (<34 weeks gestation) while "maternal preeclampsia" (maternal cardiovascular predisposition) being typically manifesting as the late form of the disease LOP is not systematically verified. Future researches are needed to propose a more adapted paradigm.
Highlights
  Risk factors for different preeclampsia phenotypes (early/late); challenging proposed models