Objective To determine the risk of pre-eclampsia associated with factors that may be present at antenatal booking.

Design Systematic review of controlled studies published 1966-2002.

Data synthesis Unadjusted relative risks were calculated from published data.

Results Controlled cohort studies showed that the risk of pre-eclampsia is increased in women with a previous history of pre-eclampsia (relative risk 7.19, 95% confidence interval 5.85 to 8.83) and in those with antiphospholipids antibodies (9.72, 4.34 to 21.75), pre-existing diabetes (3.56, 2.54 to 4.99), multiple (twin) pregnancy (2.93, 2.04 to 4.21), nulliparity (2.91, 1.28 to 6.61), family history (2.90, 1.70 to 4.93), raised blood pressure (diastolic ≥ 80 mm Hg) at booking (1.38, 1.01 to 1.87), raised body mass index before pregnancy (2.47, 1.66 to 3.67) or at booking (1.55, 1.28 to 1.88), or maternal age ≥ 40 (1.96, 1.34 to 2.87, for multiparous women). Individual studies show that risk is also increased with an interval of 10 years or more since a previous pregnancy, autoimmune disease, renal disease, and chronic hypertension.

Conclusions These factors and the underlying evidence base can be used to assess risk at booking so that a suitable surveillance routine to detect pre-eclampsia can be planned for the rest of the pregnancy.

https://www.bmj.com/content/bmj/330/7491/565.full.pdf

Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies

Perinatal outcomes in singletons following in vitro fertilization: a meta-analysis.

http://prepforbirth.com/news/wp-content/uploads/2009/07/ama-morb-and-mort.pdf

Impact of maternal age on obstetric outcome.

https://www.gums.ac.ir/Upload/Modules/Contents/asset68/Advanced%20Maternal%20Age%20and%20Adverse%20Perinatal%20Outcome.pdf

Advanced maternal age and adverse perinatal outcome.

Objective  To develop a practical evidence based list of clinical risk factors that can be assessed by a clinician at ≤16 weeks’ gestation to estimate a woman’s risk of pre-eclampsia. Design  Systematic review and meta-analysis of cohort studies. Data sources  PubMed and Embase databases, 2000-15. Eligibility criteria for selecting studies  Cohort studies with ≥1000 participants that evaluated the risk of pre-eclampsia in relation to a common and generally accepted clinical risk factor assessed at ≤16 weeks’ gestation. Data extraction  Two independent reviewers extracted data from included studies. A pooled event rate and pooled relative risk for pre-eclampsia were calculated for each of 14 risk factors. Results  There were 25 356 688 pregnancies among 92 studies. The pooled relative risk for each risk factor significantly exceeded 1.0, except for prior intrauterine growth restriction. Women with antiphospholipid antibody syndrome had the highest pooled rate of pre-eclampsia (17.3%, 95% confidence interval 6.8% to 31.4%). Those with prior pre-eclampsia had the greatest pooled relative risk (8.4, 7.1 to 9.9). Chronic hypertension ranked second, both in terms of its pooled rate (16.0%, 12.6% to 19.7%) and pooled relative risk (5.1, 4.0 to 6.5) of pre-eclampsia. Pregestational diabetes (pooled rate 11.0%, 8.4% to 13.8%; pooled relative risk 3.7, 3.1 to 4.3), prepregnancy body mass index (BMI) >30 (7.1%, 6.1% to 8.2%; 2.8, 2.6 to 3.1), and use of assisted reproductive technology (6.2%, 4.7% to 7.9%; 1.8, 1.6 to 2.1) were other prominent risk factors. Conclusions  There are several practical clinical risk factors that, either alone or in combination, might identify women in early pregnancy who are at “high risk” of pre-eclampsia. These data can inform the generation of a clinical prediction model for pre-eclampsia and the use of aspirin prophylaxis in pregnancy.

https://www.bmj.com/content/bmj/353/bmj.i1753.full.pdf

Clinical risk factors for pre-eclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies

Objective: Our purpose was to examine pregnancy outcomes among women age 40 or older. Methods: Between January, 1997 and December 1999, we performed a case-control study compared pregnancy outcomes of 468 patients delivered at our hospital at > Or = 40 years old with outcomes in a control group consisting of the next two deliveries of women with ages 20 to 29 years. Retrospective analysis of the antepartum and intrapartum records was done to compare clinical outcome. Results: Approximately 25,356 women delivered during the study period, and 468 (1.8%). Of these women were at age 40 or older. Of this latter group, 50 (10.7%) were nulliparous. Mean birthweight of infants delivered by older nulliparous women was significantly lower than that among nulliparous controls (3210 ± 5 vs. 3320 ± 1 g), whereas mean birth weight in the group of older multiparous was not different than that among younger multiparous controls (3370 ± 1 vs. 3365 ± 4 g). Gestational age at delivery was significantly lower among older nulliparous, and multiparous compared with nulliparous and multiparous younger controls. Older women were at increased risk for cesarean delivery (nulliparous 18%; multiparous 14%) compared with nulliparous and multiparous younger control groups (nulliparous 8%; multiparous 6%). In the study group, the operative vaginal delivery rate was higher than that of the control group. The study groups were more likely to develop gestational diabetes, preeclampsia, and placenta praevia. Older nulliparous had an increased incidence of malpresentation, abnormal labour patterns, special care baby unit admission (SCBU), and low 1-minute Apgar score. Older multiparous were more likely to experience birth asphyxia, premature rupture of membranes, and antepartum vaginal bleeding. Conclusion: Nulliparous women age 40 or over have a higher risk of operative delivery than do youngr nulliparous women. This increase occurs in spite of lower birth weight and gestational age and may be explained by the increase incidence of obstetric complications. Although maternal morbidity was increased in the older women, the overall neonatal outcome did not appear to be affected.

S Ziadeh

Papers

Pregnancy outcome at age 40 and older.