Women in southern Nigeria with change in paternity do not have increased incidence of pre-eclampsia

Paternal Determinants in Preeclampsia

Preeclampsia is a condition associated with high rates of maternal-fetal morbidity and mortality. It usually occurs in 3–10% of nulliparous women and 18% of previously affected women. Different lines of evidence have demonstrated the role of the father in the onset of preeclampsia. The placenta is the cornerstone of preeclampsia and poses important paternal genetic determinants; in fact, the existence of a “paternal antigen” has been proposed. Nulliparity is a well-known risk factor. Change of partner to a woman without history of preeclampsia increases the risk; however, this change decreases in women with history of the condition. High interval between pregnancies, short sexual intercourse before pregnancy, and conception by intracytoplasmic sperm injection suggest a limited exposure to the so-called paternal antigen. A man who was born from a mother with preeclampsia also increases the risk to his partner. Not only maternal but also paternal obesity is a risk factor for preeclampsia. Fetal HLA-G variants from the father increased the immune incompatibility with the mother and are also significantly associated with preeclampsia in multigravida pregnancies. An analysis of a group of Swedish pregnant women showed that the risk for preeclampsia is attributable to paternal factors in 13% of cases, which could be related to genetic interactions with maternal genetic factors. This review aimed to evaluate the evidences of the father’s contribution to the onset of preeclampsia and determine the importance of including them in future studies.

Association between gamete source, exposure and preeclampsia: A review of literature

Preeclampsia complicates 3%-5% of pregnancies and is one of the major causes of maternal morbidity and mortality. The pathologic mechanisms are well described but despite decades of research, the exact etiology of preeclampsia remains poorly understood. For years it was believed that the etiology of preeclampsia was the result of maternal factors, but recent evidence suggests that preeclampsia may be a couple specific disease where the interplay between both female and male factors plays an important role. Recent studies have suggested a complex etiologic mechanism that includes genetic imprinting, immune maladaptation, placental ischemia and generalized endothelial dysfunction. The immunological hypothesis suggests exaggerated maternal response against fetal antigens. While the role of maternal exposure to new paternal antigens in the development of preeclampsia was the initial focus of research in this area, studies examining pregnancy outcomes in pregnancies from donor oocytes provide intriguingly similar findings. The pregnancies that resulted from male or female donor gametes or donor embryos bring new insight into the role of immune response to new antigens in pathogenesis of preeclampsia. The primary goal of the current review is the role of exposure to new gametes on the development of preeclampsia. The objective was therefore to provide a review of current literature on the role of cohabitation length, semen exposure and gamete source in development of preeclampsia.

Change in paternity and select perinatal outcomes: causal or confounded?

Select social, behavioural and maternal characteristics were evaluated to determine if they were confounding factors in the association between paternity change and pre-eclampsia, small for gestational age (SGA) and pre-term delivery, in a sample of 1,409 women. Multivariate logistic regression analysis was used to determine if any of these risk factors modified the association between changing paternity and the selected perinatal outcomes. Results of the analysis showed that women who changed partners were more likely to possess potentially confounding risk factors compared with those who had not. Paternity change was 2.75 times more likely to be associated with the development of pre-eclampsia (95% CI 1.33; 5.68) and 2.25 times more likely to be associated with an SGA infant on weight (95% CI 1.13; 4.47), after adjusting for selected risk factors. Paternity change remains a significant risk factor for pre-eclampsia and SGA in the presence of select risk factors.

The effect of short duration sperm exposure on development of preeclampsia in primigravid women

BACKGROUND

Preeclampsia is one of the most serious complications, and affecting about 3% of pregnancies. The aim of this study was to estimate the impact short duration of exposure to sperm on development of preeclampsia.

METHODS

The duration of sperm exposure with the biological father (cohabitation without barrier methods) <3, <6 months were evaluated among 120 primigravid women with preeclampsia and 120 women without preeclampsia in a case-control study.

RESULTS

The short duration of exposure to sperm was more common in women with preeclampsia compared with controls (29.2 versus 14.2 for <3 months, adjOR 2.6 (95% CI=1.32-5.13) and (45 versus 29.2 for <6 months, adjOR 2.4 (95% CI=1.35-4.32). Regardless of the contraceptive method, short duration of cohabitation was more common in preeclamptic group (14.2 versus 5.8 for <3 months, adjOR 3.38 (95% CI=1.28-8.92) and (29.7 versus 13.3 for <6 months, adjOR 2.64(95% CI=1.24-5.79).

CONCLUSION

It was concluded that short duration of exposure to sperm was more common in women with preeclampsia compared with controls.

Influence of duration of sexual cohabitation on the risk of hypertension in nulliparous parturients in Ibadan: A cohort study

BACKGROUND

Hypertensive disorders of pregnancy are an important cause of maternal mortality in this environment, it accounts for about 20% of all maternal deaths in pregnancy in Nigeria.

AIM

This study aims to determine the effect of the length of sexual cohabitation on the development of hypertension in pregnancy in a Nigerian population.

MATERIALS AND METHODS

The study was a prospective cohort study; three centres were involved in the study between July 2006 and February 2009. For this study, the main outcome variable was the development of Hypertension in pregnancy. The main explanatory variable was the length of preconception sexual cohabitation. Univariate analysis was by t test, chi-squared test and Fisher's exact test for continuous and categorical variables. Multivariate analysis was by Cox hazard regression.

RESULTS

In the study population, the incidence of gestational hypertension and pre-eclampsia were 28.93% and 4.13% respectively, 29.64% had previous abortions and same paternity abortion rate was 25.92%. Length of sexual cohabitation before index pregnancy was protective against hypertension in pregnancy but not for pre-eclampsia; there was a 4% decrease in the risk of developing hypertension for every month increase in cohabitation (hazard ratio, HR 0.96 (95% CI 0.93-0.99)). Also protective in this model was same paternity abortion with a HR of 0.71 (95% CI 0.55-0.93). A previous abortion was not protective (HR 1.05 (95% CI 0.82-1.35)).

CONCLUSION

It was concluded that increased length of sexual cohabitation prior to conception reduces the risk of gestational hypertension.