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Will It Happen Again? New Risk Factors Come to Light; And 4 Other Must Read Research Studies

RISK

Early and late onset preeclampsia and small for gestational age risk in subsequent pregnancies

PLOS One

Having had preeclampsia before is a risk factor for having preeclampsia in future pregnancies. Because preeclampsia and fetal growth restriction are linked and frequently occur together, researchers asked if preeclampsia in one pregnancy increases a mother’s chance of having a small-for-gestational-age baby (meaning smaller than almost all other (95%) babies that same age) in her next pregnancy. Using a nationwide database from The Netherlands, researchers examined 265,031 mothers who had two pregnancies between 2000 and 2007 (96% of all Dutch mothers who had two babies during this time range were included in this study!). The study showed increased odds of having a small-for-gestational-age baby in a second pregnancy if the first pregnancy was complicated by early-onset preeclampsia (about double the odds when compared to moms without preeclampsia during their first pregnancy). The odds were only slightly increased (about 10%) to have a small-for-gestational-age baby for mothers with a history of late onset preeclampsia. This study is impactful because of its very large size and its nationwide reach (almost all Dutch mothers in the timeframe were included). Moreover, it gives us even more evidence that preeclampsia and fetal growth restriction are linked which can help us to learn more about the causes of these outcomes. Read the full article here.

RISK

Life stressors, hypertensive disorders of pregnancy, and preterm birth

Journal of Psychosomatic Obstetrics & Gynecology

Stress and trauma play a role in the development of heart disease, overall health, and mortality for everyone.  Maternal stress can occur as a result of life and/or pregnancy-specific stressors, such as income, partner relationships, concerns about infant health/development, living conditions, etc. This study of 4300 mothers in Utah looked at the types of stress most associated with hypertensive disorders of pregnancy (HDP), including preeclampsia, eclampsia and HELLP syndrome, and preterm labor (before 37 weeks) and found women reporting financial stress had increased likelihood of HDP and preterm birth.  Sources of financial stress prior to, during and following pregnancy included job loss, pay reduction, or difficulty in paying bills. This study is significant because it describes a modifiable risk factor of having hypertensive disorders of pregnancy. Meaning, unlike a woman’s previous pregnancy history or her genetic make-up, financial stress is something that could be changed with support, resources, and/or education. In this case, increased employment assistance, financial education programs, or bill pay assistance could be prioritized for pregnant patients as a strategy to reduce the risk of HDP. Additional studies in other states and populations, as well as studies on the impact of stress reduction methods and financial education programs, are needed to better understand the role of stress on prevention strategies. Read the full article here.

RISK

Maternal risk factors and adverse birth outcomes associated with HELLP syndrome: a population-based study 

BJOG

To identify and support timely treatment for preeclampsia and HELLP syndrome, it is critical to always keep analyzing patterns of disease among populations to stay up-to-date about what factors put pregnant patients at risk for these syndromes. Researchers in Canada used a national database of over one million delivery records to describe patients who are developing HELLP syndrome. Researchers found that the following factors were associated with higher rates of HELLP syndrome: age over 34 years old, living in a rural area, being a first time mom, having more than 3 pregnancies, having pre-pregnancy and gestational hypertension and diabetes, using assisted reproduction to become pregnant, and having chronic heart conditions, systemic lupus erythematosus, obesity, chronic liver conditions, placental disorders and congenital anomalies.  This study is impactful because it uses a very large population (over one million deliveries) to study a rare outcome, HELLP syndrome, which occurs in less than 1% of all births. The researchers studied 2,663 cases of HELLP syndrome among the dataset and are therefore able to identify these patient characteristics. Read the full article here.

PREVENTION

Impact of the ACOG guideline regarding low-dose aspirin for prevention of superimposed preeclampsia in women with chronic hypertension

Am J Obstet Gynecol

Entering pregnancy with chronic hypertension (meaning having high blood pressure before becoming pregnant) increases a patient’s risk for preeclampsia. Preeclampsia diagnosed “on top” of preexisting hypertension is called “superimposed preeclampsia”. It has been shown in other research studies that when taken as early as 12-16 weeks of pregnancy and every day until delivery, low dose aspirin can decrease risk for developing preeclampsia in patients at high-risk for preeclampsia. In 2016, the American College of Obstetricians and Gynecologists started to recommend that patients entering pregnancy with preexisting high blood pressure take 81mg of Aspirin daily to decrease their chance of developing superimposed preeclampsia. In this study, researchers asked 1) how well are doctors following this new guideline and 2) is it helping? To answer these questions, researchers analyzed data from 457 patients with preexisting high blood pressure (half before the new guidelines and half after) and compared how many patients took aspirin and how many patients went on to develop superimposed preeclampsia. The study showed that since the guidelines, 70% of the these patients were prescribed aspirin between 12 and 16 weeks of pregnancy (compared to only 7% before the new guidelines). However, researchers also reported that superimposed preeclampsia, small for gestational age, and preterm birth were not significantly decreased after prescribing aspirin 81 mg. This study, along with several similar studies cited in the paper, suggests that aspirin may be less beneficial for preventing preeclampsia in women with chronic high blood pressure. It also raised questions about the importance of dose (150 mg may be required) and when aspirin should be started (possibly sooner than 16 weeks). Read the original article here.

 

RISK

Prospective Association Between Manganese in Early Pregnancy and the Risk of Preeclampsia

Manganese, an essential dietary mineral, could play a key role in avoiding preeclampsia.  A first of its kind study found, in 1312 women followed throughout their pregnancies,  those with lower levels of manganese in early pregnancy were more likely to develop preeclampsia in late pregnancy.  Prior studies have shown those who develop preeclampsia have lower manganese levels, as compared to those without preeclampsia.  However additional studies are needed to establish a causal relationship between dietary intake of manganese and the development of preeclampsia, which could, in turn, lead to potential prevention strategies.  Until then, continue to eat a well-balanced diet, as manganese is found in many common foods, such brown rice, spinach, sweet potatoes, dark chocolate, nuts and mussels. Read original abstract here

RESEARCH ROUNDUP TEAM

Article selections for the Research Roundup are currated by Dr. Elizabeth Sutton and a team of preeclampsia experts: Dr. Jenny Sones, Dr. Alisse Hauspurg, Dr. Robin Trupp, and Dr. Felicia LeMoine. Dr. Elizabeth Sutton is the Scientific Research Director at Woman's Hospital in Baton Rouge, Louisiana. Dr. Sutton is a preeclampsia survivor and researcher with a PhD in Molecular and Developmental Biology from Louisiana State University. Dr. Sutton is dedicating her life's work to the study of preeclampsia and the dissemination of health education to preeclampsia survivors to honor her resilient daughter, Willow (born at 35 weeks from preeclampsia with severe features in 2017). Her second child, Gregory, was born in 2019 at 40 weeks after a normotensive pregnancy.

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