Severe Preeclampsia is Associated with a Positive Family History of Hypertension and Hypercholesterolemia

The effect of statins exposure during pregnancy on congenital anomalies and spontaneous abortions: A systematic review and meta-analysis

Objective: To assess the effect of statin exposure during pregnancy on congenital anomalies and spontaneous abortions.

Data sources: Electronic databases were searched from inception to January 2022.

Study Eligibility Criteria: Cohort studies and randomized controlled trials (RCTs) evaluate the effect of treatment with statins on congenital anomalies in general and cardiac malformations in particular. Studies evaluating spontaneous abortions were included as a secondary outcome.

Study appraisal and synthesis methods: Pooled odds ratio was calculated using a random-effects model and meta-regression was utilized when applicable.

Results: Twelve cohort studies and RCTs were included in the analysis. Pregnancy outcomes of 2,447 women that received statins during pregnancy were compared to 897,280 pregnant women who did not. Treatment with statins was not associated with a higher risk of overall congenital anomalies (Odd Ratio = 1.1, CI (0.9–1.3), p = 0.33, I2 = 0%). Yet, cardiac malformations were more prevalent among neonates born to statins users (OR = 1.4, CI (1.1–1.8), p = 0.02, I² = 0%). The risk was higher when exposure occurred during the first trimester. This finding was statistically significant in cohort studies, but not in RCTs. Statin treatment was also associated with a higher rate of spontaneous abortions (OR = 1.5, CI (1.1–2.0), p = 0.005, I² = 0%). In meta-regression analysis, no significant association between lipophilic statins and the rate of congenital anomalies was found.

Conclusion: Overall, treatment with statins during pregnancy was not associated with an increased risk of congenital anomalies. A slight risk elevation for cardiac malformation and spontaneous abortions was seen in cohort studies but not in RCTs.

Systematic Review Registration:clinicaltrials.gov, identifier [CRD42020165804 17/2/2020]

The meta-analysis was presented online at 42nd annual meeting of SMFM. January 31-5 February 2022.

The non-traditional and familial risk factors for preeclampsia in the FINNPEC cohort

OBJECTIVES

Considering the burden of preeclampsia (PE), it is important to understand better the underlying risk factors involved in its etiology. We studied the association of background factors with PE with an emphasis on socioeconomic factors, reproductive factors and health history enclosing the parents of pregnant women.

STUDY DESIGN

The Finnish Genetics of Pre-eclampsia Consortium (FINNPEC) cohort participants filled in a questionnaire on background information. The questionnaire data was available from 708 women with PE and 724 control women. Two different control groups, healthy controls with uncomplicated pregnancies (n = 498) and all controls (n = 724, including controls with uncomplicated pregnancies and pregnancy complications other than PE), were established.

RESULTS

PE women had similar socioeconomic status and more often non-communicable diseases including type 1 diabetes, chronic hypertension and hyperlipidemia than the two control groups (p < 0.05 for all). Depression and subfertility were more common among PE women and they had earlier menarche (p < 0.05 for all). Hypertension was more common in both parents of PE women, stroke in fathers and diabetes in mothers (p < 0.05 for all). Mental disorders including depression were more common in mothers of PE women compared to controls (PE women 7.2%, healthy controls 3.7% (p = 0.013) and all controls 3.9% (p = 0.007)).

CONCLUSIONS

In the FINNPEC cohort, PE women had similar socioeconomic status, more non-communicable diseases and depression, earlier menarche, more subfertility and more parental non-communicable diseases compared to controls. As a novel finding we found more mental disorders including depression in mothers of PE women.

A complicated pregnancy in homozygous familial hypercholesterolaemia treated with lipoprotein apheresis: A case report

BACKGROUND AND AIMS

During pregnancy total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) levels increase significantly and lipoprotein apheresis (LA) is considered the most effective therapy in homozygous familial hypercholesterolaemia (HoFH) for modulating lipid and lipoprotein levels and reducing maternal and foetal complications.

CLINICAL CASE

A primigravida 28 years old Caucasian female patient, previously diagnosed as to be HoFH, was admitted at our outpatient service at the beginning of pregnancy.

METHODS

The patient was continuously submitted to LA every two weeks without foetal complication. During pregnancy two methods have been utilised: selective apheresis, and later plasma exchange. At 33 weeks gestational age the patient developed progressively hypertension, associated to LDL-C levels increase. Weekly LA was favoured.

RESULTS

At 34 weeks +5 days patient suddenly experienced acute chest pain and abnormal electrocardiogram heart tracing and cardiac enzymes increase. An emergency caesarean section was performed without complications and the foetus was healthy. The patient was immediately transferred to Coronary Intensive Care Unit, where she was diagnosed non-ST elevation myocardial infarction (NSTEMI). Notwithstanding the patient improved in few days and was quickly discharged in fair clinical condition.

CONCLUSIONS

LA is a safe and effective tool in HoFH subjects even in pregnancy. Evidence based guidelines for the management of these patients during pregnancy are still lacking.

Risk factors associated with hypertensive disorders of pregnancy within an urban indigenous population in south western Sydney

BACKGROUND

The prevalence of hypertensive disorders of pregnancy (HDP) in Australia's urban indigenous women is unknown.

AIM

To explore the risk factors associated with HDP for a cohort of urban indigenous women in South-Western Sydney, Australia.

METHODS

This study was conducted in partnership with the Tharawal Aboriginal Medical Service. Women (18-45 years) were recruited at the clinic and community events. The quantitative questionnaire included obstetric history, personal and family history of hypertension. Anthropometric measurements and blood pressure were conducted. Rates were compared with Australian Bureau of Statistics (ABS) national rates.

RESULTS

Eighty-three participants completed the questionnaire. The rate of ever having HDP in a pregnancy was 36.1%. The overall ABS rate was 9.8% and for indigenous women, 14%. The mean maternal age at first pregnancy was 20.8 years (SD 3.7 years). The mean body mass index (BMI) of the sample population (n = 81) was 32.2 kg/m² (SD 9.5 kg/m² ) and BMI was not related to HDP (P = 0.197). Of those questioned, 25.3% had an individual history and 63.9% had a family history of hypertension. The effect of family history of hypertension (P = 0.020) (odds ratio (OR) 4.29; 95% confidence interval (CI); 1.42-12.93) and individual history of hypertension (P < 0.001) (OR 15.69; 95% CI; 4.50-54.76) were associated with HDP.

CONCLUSION

There was a higher rate of HDP in urban indigenous women compared to the national indigenous prevalence. The family history, or individual history of hypertension was the most significant risk factors and BMI was not identified as a risk factor for HDP in this population.

Why does a high-fat diet induce preeclampsia-like symptoms in pregnant rats

Changes in neurotransmitter levels in the brain play an important role in epilepsy-like attacks after pregnancy-induced preeclampsia-eclampsia. Metabotropic glutamate receptor 1 participates in the onset of lipid metabolism disorder-induced preeclampsia. Pregnant rats were fed with a high-fat diet for 20 days. Thus, these pregnant rats experienced preeclampsia-like syndromes such as tension and proteinuria. Simultaneously, metabotropic glutamate receptor 1 mRNA and protein expressions were upregulated in the rat hippocampus. These findings indicate that increased sion of metabotropic glutamate receptor 1 promotes the occurrence of high-fat diet-induced preeclampsia in pregnant rats.

The relationship of a family history for hypertension, myocardial infarction, or stroke with cardiovascular physiology in young women

Cardiovascular disease (CVD) and preeclampsia share several pathophysiologic risk factors. We examined family history (FH) and physiologic status in 60 healthy, nulliparous women to determine the relationship between FH and known risk factors for CVD. Data are presented as mean ± standard error (SE). Decreased uterine blood flow was observed in women with FH of hypertension (+FH: 21.5 ± 1.7, no FH: 33.3 ± 9.0 mL/min; P = .04). Women reporting an FH of stroke showed increased alpha- and beta-adrenergic response, as measured by Valsalva maneuver (α: FH: 24.7 ± 1.9, -FH: 18.9 ± 1.1 mm Hg, P = .02; β: FH: 22.0 ± 2.1, -FH: 16.9 ± 1.4 mm Hg; P = .04), and increased cardiac output (4.83 ± 0.22 vs 4.31 ± 0.12 L/min; P = .01). We identified no significant physiologic associations linked to an FH of myocardial infarction. Our observations show significant differences in physiologic characteristics in women with specific CVD family histories. These data, coupled with known heritable contributions to CVD and preeclampsia, suggest a distinct physiologic phenotype that may link preeclampsia risk with FH of CVD, independent of pregnancy.

Pregnancy-induced hypertension is associated with maternal history and a risk of cardiovascular disease in later life: Japanese cross-sectional study

OBJECTIVE

To clarify the associations between pregnancy-induced hypertension (PIH) with heritability of PIH from mother to daughter and the risk of cardiovascular disease in later life in Japanese women.

STUDY DESIGN

The Japan Nurses' Health Study (JNHS) is a cohort study of Japanese women's health. Data from the JNHS baseline survey between 2001 and 2007 were used to conduct a cross-sectional analysis. Of the 49,927 respondents in the baseline survey, 10,456 parous women who were ≥45 years old at baseline were included in the analysis.

MAIN OUTCOME MEASURES

The age-adjusted odds ratio (OR) of PIH in women whose mother had a history of PIH, and the age-adjusted OR of PIH in participants for hypertension, hypercholesterolemia and diabetes mellitus (DM).

RESULTS

The age-adjusted OR of PIH was 2.72 (95% confidence interval [CI]: 2.14-3.46) in women whose mother had a history of PIH compared with those whose mother did not have PIH. PIH was a risk factor for hypertension (age adjusted OR: 2.85, 95% CI: 2.45-3.11), hypercholesterolemia (age-adjusted OR: 1.49, 95% CI: 1.29-1.72) and DM (age-adjusted OR: 1.53, 95% CI: 1.11-2.11), as determined by logistic regression analysis.

CONCLUSIONS

In Japanese women, the risk of PIH is approximately 2.7-fold greater in those whose mothers also had PIH compared with those whose mothers did not. PIH is a risk factor for hypertension, hypercholesterolemia, and diabetes mellitus in later life.

Risk of cardiovascular disease after pre-eclampsia and the effect of lifestyle interventions: a literature-based study

OBJECTIVE

This study addresses the following questions. Do cardiovascular risk factors fully explain the odds ratio of cardiovascular risk after pre-eclampsia? What is the effect of lifestyle interventions (exercise, diet, and smoking cessation) after pre-eclampsia on the risk of cardiovascular disease?

DESIGN

Literature-based study.

SETTING

N/A.

POPULATION OR SAMPLE

N/A.

METHODS

Data for the calculations were taken from studies identified by PubMed searches. First, the differences in cardiovascular risk factors after pre-eclampsia compared with an uncomplicated pregnancy were estimated. Second, the effects of lifestyle interventions on cardiovascular risk were estimated. Validated risk prediction models were used to translate these results into cardiovascular risk.

RESULTS

After correction for known cardiovascular risk factors, the odds ratios of pre-eclampsia for ischaemic heart disease and for stroke are 1.89 (IQR 1.76-1.98) and 1.55 (IQR 1.40-1.71), respectively. After pre-eclampsia, lifestyle interventions on exercise, dietary habits, and smoking cessation decrease cardiovascular risk, with an odds ratio of 0.91 (IQR 0.87-0.96).

CONCLUSIONS

Cardiovascular risk factors do not fully explain the risk of cardiovascular disease after pre-eclampsia. The gap between estimated and observed odds ratios may be explained by an additive risk of cardiovascular disease by pre-eclampsia. Furthermore, lifestyle interventions after pre-eclampsia seem to be effective in decreasing cardiovascular risk. Future research is needed to overcome the numerous assumptions we had to make in our calculations.

Serum anti-müllerian hormone levels in healthy females: a nomogram ranging from infancy to adulthood

CONTEXT

Anti-müllerian hormone (AMH) is an accurate marker of ovarian reserve. However, sufficiently large sets of normative data from infancy to the end of reproductive life are scarce.

OBJECTIVE

This study was an assessment of serum AMH levels in healthy females.

SUBJECTS

In 804 healthy females ranging from infancy until the end of the reproductive period, serum AMH levels were measured with an enzyme-linked immunometric assay. All adults had regular menstrual cycles. The majority was proven fertile and none of them had used oral contraceptive pills prior to study inclusion.

RESULTS

In the total cohort, AMH was inversely correlated with age (r = -0.24; P < 0.001). The age at which the maximum AMH value was attained was at 15.8 yr. In girls younger than 15.8 yr, serum AMH and age were positively correlated (r = +0.18; P = 0.007). Thereafter AMH levels remained stable (r = -0.33; P = 0.66), whereas from the age of 25.0 yr onward, an inverse correlation between AMH and age (r = -0.47; P < 0.001) was observed. At any given age, considerable interindividual differences in serum AMH levels were observed.

CONCLUSION

During infancy AMH levels increase, whereas during adolescence, a plateau until the age of 25 yr was observed. From the age of 25 yr onward, serum AMH levels correlate inversely with age, implying that AMH is applicable as a marker of ovarian reserve only in women of 25 yr old and older. Our nomogram may facilitate counseling women on their reproductive potential.

Cardiovascular function in women with recurrent miscarriage, pre-eclampsia and/or intrauterine growth restriction

OBJECTIVE

To investigate prepregnancy cardiovascular function and risk factors in women with previous pregnancy complications.

METHODS

Thirty-four women with previous normal pregnancy (controls), 26 with unexplained recurrent miscarriage (RM) and 14 with pre-eclampsia (PE) and/or intrauterine growth restriction (IUGR), planning to conceive were recruited. Brachial and central blood pressures (BP), cardiac output (CO), peripheral vascular resistance (PVR), aortic stiffness, blood biochemistry and platelet aggregation were assessed.

RESULTS

Women with previous PE/IUGR had higher brachial diastolic BP (78 ± 9 vs 71 ± 7 mmHg; p = 0.03), central systolic BP (107 ± 10 vs 99 ± 8 mmHg; p = 0.03), mean arterial pressure (92 ± 10 vs 84 ± 8 mmHg; p = 0.01) and PVR (1499 ± 300 vs 1250 ± 220 dynes.s(-1) cm(-5); p = 0.005), than the controls. No differences were observed in either cardiovascular function or blood biochemistry in women with unexplained RM compared with the controls. Women with previous PE/IUGR though not with RM had a stronger family history of cardiovascular disease (CVD) than controls.

CONCLUSIONS

Women with previous PE and/or IUGR had higher BP and PVR compared with controls, which may predispose them to CVD later in life. However, in the absence of underlying vascular pathology, women with unexplained RM did not have abnormal cardiovascular function. Prepregnancy period provides an opportunity to identify cardiovascular risks in relation to previous obstetric history.

Risk factors of early and late onset pre-eclampsia

AIMS

The aim of this study was to identify the differences in risk factors between early and late onset pre-eclampsia.

MATERIAL AND METHODS

A case-control study was carried out involving pregnancies with pre-eclampsia (152 early onset and 297 late onset) and 449 controls at King Chulalongkorn Memorial Hospital, Bangkok, Thailand between 1 January 2005 and 31 December 2010. The data were reviewed from antenatal and delivery records.

RESULTS

Factors which were significantly associated with increased risk for both early and late onset pre-eclampsia were family history of diabetes mellitus, high pre-pregnancy body mass index ≥ 25 kg/m(2) and weight gain ≥ 0.5 kg per week. History of chronic hypertension (odds ratio 4.4; 95% confidence interval 2.1-9.3) was significantly associated with increased risk for only early onset pre-eclampsia, while family history of chronic hypertension (odds ratio 18; 95% confidence interval 6-54) was significantly associated with increased risk for only late onset pre-eclampsia.

CONCLUSIONS

The risk factors that differ between early and late onset of pre-eclampsia were history of chronic hypertension and family history of chronic hypertension. Family history of diabetes mellitus, pre-pregnancy body mass index ≥ 25 kg/m(2) and weight gain ≥ 0.5 kg per week were risk factors of both early and late onset pre-eclampsia. These risk factors are of value to obstetricians in identifying patients at risk for pre-eclampsia and in implementing primary prevention.

Vascular associated gene variants in patients with preeclampsia: results from the Danish National Birth Cohort

OBJECTIVE

Preeclampsia has been linked to subsequent vascular disease with many shared predisposing factors. We investigated the association between severe preeclampsia, and its subtypes, and specific vascular-related polymorphisms.

DESIGN

The study was a retrospective nested case-cohort design.

SETTING

Pregnant Danish women participating in the Danish National Birth Cohort. Population. 263 cases of severe preeclampsia and 1851 random controls were selected from the Danish National Birth Cohort.

METHODS

We validated all cases of severe preeclampsia and genotyped for 108 single nucleotide polymorphisms (SNPs) that were selected based on previous publications on the association with vascular disease. Logistic models were used for statistical analyses.

MAIN OUTCOME MEASURES

Maternal polymorphisms in genomic models.

RESULTS

We found 17 of 108 SNPs associated with severe preeclampsia (p < 0.05). Women homozygous for the rs1799983 in NOS3 were 1.6-fold [95% confidence interval (CI) 1.0-2.4] more likely to develop severe preeclampsia. Women homozygous for the rs1010 SNP in VAMP8 were twofold (95%CI 1.1-3.5) more likely to deliver preterm when preeclampsia was present. Women homozygous for the rs10811661 SNP were 2.1-fold (95%CI 1.1-3.9) more likely to develop severe preeclampsia and 3.7-fold (95%CI 1.1-12.4) more likely to deliver a small-for-gestational age child when preeclampsia was present. All associations are available as Supporting Information.

CONCLUSION

We found several vascular-associated SNPs linked to severe preeclampsia; however, most of these associations are probably by pure chance, which warrants replication and further translational research. To date, no specific SNP has yet proven valuable in a clinical setting in predicting preeclampsia.

Risk factors for pre-eclampsia in Mulago Hospital, Kampala, Uganda

OBJECTIVE

Pre-eclampsia contributes significantly to maternal, foetal and neonatal morbidity and mortality. The risk factors for pre-eclampsia have not been well documented in Uganda. In this paper, we describe the risk factors for pre-eclampsia in women attending antenatal clinics at Mulago Hospital, Kampala.

METHODS

This casecontrol study was conducted from 1st May 2008 to 1st May 2009. 207 women with pre-eclampsia were the cases, and 352 women with normal pregnancy were the controls. The women were 15-39 years old, and their gestational ages were 20 weeks or more. They were interviewed about their socio-demographic characteristics, past medical history and, their past and present obstetric performances.

RESULTS

The risk factors were low plasma vitamin C (OR 3.19, 95% CI: 1.54-6.61), low education level (OR 1.67, 95% CI: 1.12-2.48), chronic hypertension (OR 2.29, 95% CI 1.12-4.66), family history of hypertension (OR 2.25, 95% CI: 1.53-3.31) and primiparity (OR 2.76, 95% CI: 1.84-4.15) and para≥5 (3.71, 95% CI:1.84-7.45).

CONCLUSION

The risk factors identified are similar to what has been found elsewhere. Health workers need to identify women at risk of pre-eclampsia and manage them appropriately so as to prevent the maternal and neonatal morbidity and mortality associated with this condition.

Association of Remote Hypertension in Pregnancy With Coronary Artery Disease

Because hypertensive pregnancies have been associated with increased cardiovascular disease, we aimed to identify whether angiographically characterized coronary artery disease differed in women with previous normotensive pregnancies or hypertensive pregnancies (HPs). The study group included 217 parous women, aged 60.9±9.2 (SD) years, who required coronary angiography between January 2006 and December 2007, 36.8±9.9 and 28.8±10.5 years after their first and last pregnancy, respectively; 146 had normotensive pregnancies and 71 had ≥1 HP, according to a questionnaire including reproductive history and cardiovascular risks. Body mass index, smoking, and frequency of diabetes were similar in both groups. Chronic hypertension (93% versus 78%; P =0.007), hyperlipidemia (82% versus 69%; P =0.049), and premature familial cardiovascular disease (42% versus 20%; P =0.001) prevailed in HPs. Participants with HPs were younger (58.9±8.3 versus 61.9±9.6 years; P =0.025) than participants with normotensive pregnancies. Although 49% of all participants had hemodynamically significant coronary artery disease (≥70% stenosis), no differences were observed between groups in the number of stenotic arteries; however, their number increased by 28% and 22% over a 10-year period in HPs and normotensive pregnancies, respectively ( P =0.034). Multivariate analysis showed that HPs had a nonsignificant risk of having coronary artery disease (odds ratio: 1.21; 95% CI: 0.64 to 2.28), and being a current smoker (odds ratio: 4.13; 95% CI: 1.85 to 9.25), a diabetic (odds ratio: 2.29; 95% CI: 1.85 to 9.25), or having a family history of premature cardiovascular disease (odds ratio: 2.34; 95% CI: 1.17 to 2.39) significantly increased the risk of coronary artery disease. This study demonstrates that women with HPs have earlier coronary disease, probably related to intermediate cardiovascular risks that have a gestational expression.

Shared Constitutional Risks for Maternal Vascular-Related Pregnancy Complications and Future Cardiovascular Disease

Maternal predisposition to vascular and metabolic disease may underlie both vascular-related pregnancy complications, such as preeclampsia and intrauterine growth restriction, as well as future maternal cardiovascular disease. We aimed to substantiate this hypothesis with biochemical and anthropometric evidence by conducting an intergenerational case-control study in a Dutch isolated population including 106 women after preeclampsia or intrauterine growth restriction (median follow-up: 7.1 years) and their fathers (n=43) and mothers (n=64), as well as 106 control subjects after uncomplicated pregnancies with their fathers (n=51) and mothers (n=68). Cardiovascular risk profiles were assessed, including fasting glucose, lipids, anthropometrics, blood pressure, intima-media thickness, and metabolic syndrome. We found significantly higher fasting glucose levels, larger waist circumferences, and a 5-fold increased prevalence of hypertension in women with a history of preeclampsia as compared with control subjects ( P <0.001). Likewise, their parents had higher glucose levels than control parents ( P <0.05). Their mothers had larger waist circumferences and higher blood pressures ( P <0.05). Also, women after pregnancies complicated by intrauterine growth restriction had higher glucose levels and increased prevalence of hypertension ( P <0.01). Their fathers showed higher glucose levels as well ( P <0.05). Mean carotid intima-media thickness was increased in a subset of women after preeclampsia diagnosed with chronic hypertension as compared with those without hypertension ( P <0.01). Metabolic syndrome was more prevalent both in women with a history of preeclampsia and their mothers ( P <0.05). We demonstrated intergenerational similarities in cardiovascular risk profiles between women after preeclampsia or intrauterine growth restriction and their parents. These findings suggest shared constitutional risks for vascular-related pregnancy complications and future cardiovascular disease.

Endothelial dysfunction: a link among preeclampsia, recurrent pregnancy loss, and future cardiovascular events?

We tested the hypothesis that endothelial dysfunction could cause placentation-related defects, persist after the complicated pregnancy, and probably cause cardiovascular disease later in life. Brachial arterial reactivity and factors related to endothelial dysfunction, such as circulating cholesterol, uric acid, nitrites, l-arginine, asymmetrical dimethylarginine, vascular endothelial growth factor, and soluble vascular endothelial growth factor receptor-1, in women with previous healthy pregnancies (n=22), patients with severe preeclampsia (n=25), or patients with recurrent pregnancy loss (n=29), at day 10 of the luteal phase of an ovulatory cycle an average of 11 to 27 months after pregnancy were evaluated. Both groups with placentation defects had a significant decrease in endothelium-dependent dilatation, a higher rate of endothelial dysfunction, lower serum nitrites, and higher cholesterol as compared with control subjects; subjects with previous preeclampsia additionally had higher normal blood pressures and a greater parental prevalence of cardiovascular disease. Patients with recurrent pregnancy loss also demonstrated a significantly lower endothelium-independent vasodilatation. A trend to an inverse correlation was found between serum cholesterol serum and endothelial-mediated vasodilatation in the whole study population. Uric acid, l-arginine, asymmetrical dimethylarginine, vascular endothelial growth factor, and soluble vascular endothelial growth factor receptor-1 were similar in all of the groups. We postulate that endothelial dysfunction may represent a link between preeclampsia and increased cardiovascular disease latter in life and propose that women with unexplained recurrent miscarriages are also at increased cardiovascular risk. The identification and correction of endothelial dysfunction detected during the reproductive stage on obstetric outcome and on cardiovascular diseases needs to be elucidated.

Family history of early-onset cardiovascular disorders is associated with a higher risk of severe preeclampsia

AIM

The aim was to evaluate familial early-onset cardiovascular disorders as potential risk factors for severe preeclampsia.

STUDY DESIGN

A case-control study was carried out by interviewing 162 primiparous severely preeclamptic women and 521 primiparous healthy control patients after delivery to determine the frequency of cardiovascular disorders (chronic hypertension, myocardial infarction, stroke) developed before the age of 50 among their parents. The chi2-test was utilized to estimate odds ratios (OR) and 95% confidence intervals (95% CI). The association was adjusted for pre-pregnancy body mass index, maternal age, and smoking habits before pregnancy using logistic regression analysis.

RESULTS

Maternal and paternal early-onset chronic hypertension (adjusted OR: 3.84, 95% CI: 2.25-6.54; and adjusted OR: 3.26, 95% CI: 1.76-6.05) as well as paternal early-onset myocardial infarction (adjusted OR: 3.33; 95% CI: 1.51-7.32) were independent risk factors for severe preeclampsia. Early-onset stroke affected only the fathers of severely preeclamptic patients. Among the severely preeclamptic patients a positive family history of cardiovascular disorders developed before the age of 50 increased the risk of early-onset preeclampsia (developing before the 32nd gestational week) by 5.05-fold (95% CI: 3.08-8.31) compared with the control group.

CONCLUSION

Our results suggest that the presence of familial early-onset cardiovascular disorders is a predisposing factor for severe preeclampsia.