Risk Indicators for Eclampsia in Gestational Hypertension or Mild Preeclampsia at Term

Abstract

Objective. To evaluate whether eclampsia can be predicted in gestational hypertension or mild preeclampsia at term. Methods. For this case–control study we selected 76 cases with eclampsia from the LEMMoN study and 1149 controls with mild hypertensive disease of pregnancy, who did not develop eclampsia, from the HYPITAT study. Risk indicators for eclampsia, identified in multivariable logistic regression, were used to assess the predictive capacity of our model with receiver-operating characteristic (ROC) curve analysis. Model optimism was assessed with bootstrapping. Results. Maternal age, non-Caucasian ethnicity, systolic blood pressure >155 mmHg, ≥2+ protein on dipstick, elevated uric acid, creatinin >74 μmol/L, aspartate aminotransferase >30 U/L, and lactate dehydrogenase >400 U/L were significantly associated with eclampsia. Other factors included in the model were previous fetal loss, previous miscarriage, gestational age, and low platelet count. The area under the ROC curve was 0.92. Bootstrapping showed minimal overfitting of the model. Conclusion. In women with gestational hypertension or mild preeclampsia at term eclampsia can be predicted.

• Gestational hypertension
• (Pre) eclampsia
• Predictive value
• Risk indicators
• Receiver-operating characteristic curve analysis

ACKNOWLEDGMENTS

We strongly thank Prof. Dr. J.P. Vandenbroucke for his epidemiological advice. Further, we thank the members of the LEMMoN expert panel for their contribution and all local coordinators who kindly participated (9). We thank research nurses and midwives of our consortium for their help in patient recruitment and data collection for the HYPITAT trial. We also thank all members of the HYPITAT study group (5).

Ethics Approval

The LEMMoN and HYPITAT studies were centrally approved by the medical ethics committee of Leiden University Medical Centre (LEMMoN: P04-020; HYPITAT: P04·210) and the HYPITAT trial had local approval from the boards of the other participating hospitals. The HYPITAT trial is registered in the clinical trial register as ISRCTN08132825.

Funding

The LEMMoN study was funded by the Dutch Organisation for Health Research (ZonMw; Grant 3610.0024) and the Matty Brand Foundation. The HYPITAT trial was funded by the Dutch Organisation for Health Research (ZonMw; Grant 945-06-553). The funding sources had no role in study design, data collection, data analysis, data interpretation, writing of the report, or the decision to submit the paper for publication.

Declaration of Interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this paper.