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

Abstract

Objectives

To present a comprehensive overview of different risk factors for early onset preeclampsia (<34 weeks gestation, EOP) vs. late onset (LOP).

Study design

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.

Main outcome measures

Comparing risk factors between EOP and LOP.

Results

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.

Conclusion

“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

Keywords:

• Preeclampsia
• epidemiology
• early onset preeclampsia
• late onset preeclampsia
• body mass index

Disclosure statement

No potential conflict of interest was reported by the author(s).

Authors contributions

PYR participated at all the stages of the study (data collection, analysis, writings et.). TH verified all the epidemiological calculations and participated deeply to the data analysis. GD, MS, and TC expertised the analysis, the text and the final writings (and the English Language). SI, MB, and FB participated at the data collection, analysis and writings.

Additional information

Funding

No specific fundings besides the French government funding for the South-Reunion perinatal database.