Skip to main content

Advertisement

SpringerLink
Log in

Pre-eclampsia: An Update

  • Hypertensive Emergencies (BM Baumann, Section Editor)
  • Published:
Current Hypertension Reports Aims and scope Submit manuscript

Abstract

Pre-eclampsia remains the second leading direct cause of maternal death, >99 % of which occurs in less developed countries. Over 90 percent of the observed reduction in pre-eclampsia-related maternal deaths in the UK (1952–2008) occurred with antenatal surveillance and timed delivery. In this review, we discuss the pathogenesis, diagnostic criteria, disease prediction models, prevention and management of pre-eclampsia. The Pre-eclampsia Integrated Estimate of RiSk (PIERS) models and markers of angiogenic imbalance identify women at incremental risk for severe pre-eclampsia complications. For women at high risk of developing pre-eclampsia, low doses of aspirin (especially if started <17 weeks) and calcium are evidence-based preventative strategies; heparin is less so. Severe hypertension must be treated and the Control of Hypertension In Pregnancy (CHIPS) Trial (reporting: 2014) will guide non-severe hypertension management. Magnesium sulfate prevents and treats eclampsia; there is insufficient evidence to support alternative regimens. Pre-eclampsia predicts later cardiovascular disease; however, at this time we do not know what to do about it.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Steegers EA, von Dadelszen P, Duvekot JJ, Pijnenborg R. Pre-eclampsia. Lancet 2010;376(9741):631–44.

    Google Scholar 

  2. Hutcheon JA, Lisonkova S, Joseph KS. Epidemiology of pre-eclampsia and the other hypertensive disorders of pregnancy. Best Pract Res Clin Obstet Gynaecol. 2011;25(4):391–403.

    PubMed  Google Scholar 

  3. National Collaborating Centre for Women’s and Children’s Health. Hypertension in pregnancy: the management of hypertensive disorders during pregnancy. London: National Institute for Health and Clinical Excellence; 2010. Report No.: CG107.

  4. World Health Organization. World Health Organization recommendations for preventation and treatment of pre-eclampsia and eclampsia. Geneva: World Health Organization; 2011.

    Google Scholar 

  5. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013;122(5):1122–31.

  6. Tranquili AL, Dekker G, Magee L, Roberts J, Sibai BM, Steyn W, et al. The classification, diagnosis and management of the hypertensive disorders of pregnancy: A revised statement from the ISSHP. Pregnancy Hypertens 2014;4(2):97–104.

  7. Magee LA, Pels A, Helewa M, Rey E, von Dadelszen P, the Canadian Hypertensive Disorders of Pregnancy (HDP) Working Group. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. J Obstet Gynaecol Can 2014;36(5):416–438.

  8. Magee LA, Pels A, Helewa M, Rey E, von Dadelszen P, the Canadian Hypertensive Disorders of Pregnancy (HDP) Working Group. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. Pregnancy Hypertens 2014;4(2):105–45. This pair of papers provides the most up-to-date guidance to direct clincial care. The redefinition of what constitutes ‘severe’ pre-eclampsia to include only clinical variables that mandate delivery will provide greater clinical clarity than previous documents.

    Google Scholar 

  9. Payne BA, Hutcheon JA, Ansermino JM, Hall DR, Bhutta ZA, Bhutta SZ, et al. A risk prediction model for the assessment and triage of women with hypertensive disorders of pregnancy in low-resourced settings: the miniPIERS (Pre-eclampsia Integrated Estimate of RiSk) multi-country prospective cohort study. PLoS Med. 2014;11(1), e1001589. The demographics-, symptom- and sign-based miniPIERS model will direct community-level diagnosis and triage of women with pre-eclampsia in all settings.

    PubMed  PubMed Central  Google Scholar 

  10. von Dadelszen P, Payne B, Li J, Ansermino JM, Broughton PF, Cote AM, et al. Prediction of adverse maternal outcomes in pre-eclampsia: development and validation of the fullPIERS model. Lancet. 2011;377(9761):219–27.

    Google Scholar 

  11. Menzies J, Magee LA, MacNab YC, Ansermino JM, Li J, Douglas MJ, et al. Current CHS and NHBPEP criteria for severe preeclampsia do not uniformly predict adverse maternal or perinatal outcomes. Hypertens Pregnancy. 2007;26(4):447–62.

    CAS  PubMed  Google Scholar 

  12. Redman CW, Sargent IL. Latest advances in understanding preeclampsia. Science. 2005;308(5728):1592–4.

    CAS  PubMed  Google Scholar 

  13. von Dadelszen P, Magee LA, Roberts JM. Subclassification of preeclampsia. Hypertens Pregnancy. 2003;22(2):143–8.

    Google Scholar 

  14. Rana S, Cerdeira AS, Wenger J, Salahuddin S, Lim KH, Ralston SJ, et al. Plasma concentrations of soluble endoglin versus standard evaluation in patients with suspected preeclampsia. PLoS One. 2012;7(10):e48259.

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Rana S, Karumanchi SA, Lindheimer MD. Angiogenic factors in diagnosis, management, and research in preeclampsia. Hypertension. 2014;63(2):198–202.

    CAS  PubMed  Google Scholar 

  16. Chappell LC, Duckworth S, Seed PT, Griffin M, Myers J, Mackillop L, et al. Diagnostic accuracy of placental growth factor in women with suspected preeclampsia: a prospective multicenter study. Circulation. 2013;128(19):2121–31. This paper provides a breakthrough in our ability to integrate a translational biomarker into clinical care. Placental growth factors not only assist in the diagnosis of pre-eclampsia, it identifies women at incremental risk of imminent delivery.

    CAS  PubMed  Google Scholar 

  17. Staff AC, Benton SJ, von Dadelszen P, Roberts JM, Taylor RN, Powers RW, et al. Redefining preeclampsia using placenta-derived biomarkers. Hypertension. 2013;61(5):932–42. The paper looks to redefining subtypes of pre-eclampsia on the basis of placental biomarkers, particularly angiongenic imbalance. Through better understanding of the pathogenesis of pre-clampsia we will be able to design effective prediction, prevention and treatment straetgies.

    CAS  PubMed  Google Scholar 

  18. Benton SJ, Hu Y, Xie F, Kupfer K, Lee SW, Magee LA, et al. Angiogenic factors as diagnostic tests for preeclampsia: a performance comparison between two commercial immunoassays. Am J Obstet Gynecol. 2011;205(5):469.e1–8.

    Google Scholar 

  19. Benton SJ, Hu Y, Xie F, Kupfer K, Lee SW, Magee LA, et al. Can placental growth factor in maternal circulation identify fetuses with placental intrauterine growth restriction? Am J Obstet Gynecol. 2012;206(2):163–7. Angiogenic imbalance is not specific to pre-eclampsia.

    PubMed  Google Scholar 

  20. Myatt L, Clifton RG, Roberts JM, Spong CY, Hauth JC, Varner MW, et al. First-trimester prediction of preeclampsia in nulliparous women at low risk. Obstet Gynecol. 2012;119(6):1234–42.

    PubMed  PubMed Central  Google Scholar 

  21. Kenny LC, Broadhurst DI, Dunn W, Brown M, North RA, McCowan L, et al. Robust early pregnancy prediction of later preeclampsia using metabolomic biomarkers. Hypertension. 2010;56(4):741–9.

    CAS  PubMed  Google Scholar 

  22. Myers JE, Kenny LC, McCowan LM, Chan EH, Dekker GA, Poston L, et al. Angiogenic factors combined with clinical risk factors to predict preterm pre-eclampsia in nulliparous women: a predictive test accuracy study. BJOG. 2013;120(10):1215–23. This study begins to integrate placental growth factor into clinical outcome prediction modeling to identify women at increased risk for pre-eclampsia later in their pregnancy. Such women would be priorities for current prevention strategies and comprise an enriched cohort for future attempts at disease prevention related to a specific pathway to disease.

    CAS  PubMed  Google Scholar 

  23. North RA, McCowan LM, Dekker GA, Poston L, Chan EH, Stewart AW, et al. Clinical risk prediction for pre-eclampsia in nulliparous women: development of model in international prospective cohort. BMJ. 2011;342:d1875.

    PubMed  PubMed Central  Google Scholar 

  24. North RA, Simmons D, Barnfather D, Upjohn M. What happens to women with preeclampsia? Microalbuminuria and hypertension following preeclampsia. Aust N Z J Obstet Gynaecol. 1996;36(3):233–8.

    CAS  PubMed  Google Scholar 

  25. Blumenstein M, McMaster MT, Black MA, Wu S, Prakash R, Cooney J, et al. A proteomic approach identifies early pregnancy biomarkers for preeclampsia: novel linkages between a predisposition to preeclampsia and cardiovascular disease. Proteomics. 2009;9(11):2929–45.

    CAS  PubMed  Google Scholar 

  26. Carty DM, Siwy J, Brennand JE, Zurbig P, Mullen W, Franke J, et al. Urinary proteomics for prediction of preeclampsia. Hypertension. 2011;57(3):561–9.

    CAS  PubMed  Google Scholar 

  27. Kolla V, Jeno P, Moes S, Lapaire O, Hoesli I, Hahn S. Quantitative proteomic (iTRAQ) analysis of 1st trimester maternal plasma samples in pregnancies at risk for preeclampsia. J Biomed Biotechnol. 2012;2012:305964.

    PubMed  PubMed Central  Google Scholar 

  28. Lee SM, Park JS, Norwitz ER, Kim SM, Kim BJ, Park CW, et al. Characterization of discriminatory urinary proteomic biomarkers for severe preeclampsia using SELDI-TOF mass spectrometry. J Perinat Med. 2011;39(4):391–6.

    CAS  PubMed  Google Scholar 

  29. Oh KJ, Park JS, Norwitz ER, Kim SM, Kim BJ, Park CW, et al. Proteomic biomarkers in second trimester amniotic fluid that identify women who are destined to develop preeclampsia. Reprod Sci. 2012;19(7):694–703.

    CAS  PubMed  Google Scholar 

  30. Rasanen J, Girsen A, Lu X, Lapidus JA, Standley M, Reddy A, et al. Comprehensive maternal serum proteomic profiles of preclinical and clinical preeclampsia. J Proteome Res. 2010;9(8):4274–81.

    CAS  PubMed  Google Scholar 

  31. Navaratnam K, Alfirevic Z, Baker PN, Gluud C, Gruttner B, Kublickiene K, et al. A multi-centre phase IIa clinical study of predictive testing for preeclampsia: improved pregnancy outcomes via early detection (IMPROvED). BMC Pregnancy Childbirth. 2013;13:226.

    PubMed  PubMed Central  Google Scholar 

  32. Dodd JM, McLeod A, Windrim RC, Kingdom J. Antithrombotic therapy for improving maternal or infant health outcomes in women considered at risk of placental dysfunction. Cochrane Database Syst Rev. 2013;7, CD006780.

    Google Scholar 

  33. Rodger MA, Carrier M, Le Gal G, Martinelli I, Perna A, Rey E, et al. Meta-analysis of low-molecular-weight heparin to prevent recurrent placenta-mediated pregnancy complications. Blood. 2014;123(6):822–8.

    CAS  PubMed  Google Scholar 

  34. Hofmeyr GJ, Lawrie TA, Atallah AN, Duley L. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev. 2010;8, CD001059.

    Google Scholar 

  35. Li K, Kaaks R, Linseisen J, Rohrmann S. Associations of dietary calcium intake and calcium supplementation with myocardial infarction and stroke risk and overall cardiovascular mortality in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition study (EPIC-Heidelberg). Heart. 2012;98(12):920–5.

    CAS  PubMed  Google Scholar 

  36. Jarjou LM, Laskey MA, Sawo Y, Goldberg GR, Cole TJ, Prentice A. Effect of calcium supplementation in pregnancy on maternal bone outcomes in women with a low calcium intake. Am J Clin Nutr. 2010;92(2):450–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  37. Jarjou LM, Sawo Y, Goldberg GR, Laskey MA, Cole TJ, Prentice A. Unexpected long-term effects of calcium supplementation in pregnancy on maternal bone outcomes in women with a low calcium intake: a follow-up study. Am J Clin Nutr. 2013;98(3):723–30. High-dose calcium supplementation in pregnancy may have unintended consequences for maternal bone health.

    CAS  PubMed  PubMed Central  Google Scholar 

  38. Hofmeyr G, Belizan J, von Dadelszen P. Low-dose calcium supplementation for preventing pre-eclampsia: a systematic review and commentary. BJOG 2014 [Epub ahead of print]. Low-dose calcium replacement to RDA levels in women with low calcium intake is equally as effective as high-dose supplementation.

  39. Askie LM, Duley L, Henderson-Smart DJ, Stewart LA. Antiplatelet agents for prevention of pre-eclampsia: a meta-analysis of individual patient data. Lancet. 2007;369(9575):1791–8.

    CAS  PubMed  Google Scholar 

  40. Duley L, Henderson-Smart DJ, Meher S, King JF. Antiplatelet agents for preventing pre-eclampsia and its complications. Cochrane Database Syst Rev. 2007;2, CD004659.

    Google Scholar 

  41. Roberge S, Giguere Y, Villa P, Nicolaides K, Vainio M, Forest JC, et al. Early administration of low-dose aspirin for the prevention of severe and mild preeclampsia: a systematic review and meta-analysis. Am J Perinatol 2014 Jun;31(6):e3.

    Google Scholar 

  42. ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002. Obstet Gynecol. 2002;99(1):159–67.

    Google Scholar 

  43. Redman CW. Fetal outcome in trial of antihypertensive treatment in pregnancy. Lancet. 1976;2(7989):753–6.

    CAS  PubMed  Google Scholar 

  44. Redman CW, Beilin LJ, Bonnar J. Treatment of hypertension in pregnancy with methyldopa: blood pressure control and side effects. Br J Obstet Gynaecol. 1977;84(6):419–26.

    CAS  PubMed  Google Scholar 

  45. Eclampsia Trial Collaborative Group. Which anticonvulsant for women with eclampsia? Evidence from the Collaborative Eclampsia Trial. Lancet. 1995;345(8963):1455–63.

  46. Altman D, Carroli G, Duley L, Farrell B, Moodley J, Neilson J, et al. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial. Lancet. 2002;359(9321):1877–90.

    PubMed  Google Scholar 

  47. Hezelgrave N, de Greef A, Irvine L, Seed P, Radford S, Shennan A. PP058. CRADLE: Community blood pressure monitoring in rural Africa: Detection of underlying pre-eclampsia [abstract]. Pregnancy Hypertens. 2013;3(2):88. The Microlife BP3AS1-2 sphygmomanometer is a low-cost, accurate blood pressure device amenable for use in all settings.

    PubMed  Google Scholar 

  48. Wen SW, Kramer MS, Hoey J, Hanley JA, Usher RH. Terminal digit preference, random error, and bias in routine clinical measurement of blood pressure. J Clin Epidemiol. 1993;46(10):1187–93.

    CAS  PubMed  Google Scholar 

  49. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507–20.

    CAS  PubMed  Google Scholar 

  50. Cote AM, Firoz T, Mattman A, Lam EM, von Dadelszen P, Magee LA. The 24-hour urine collection: gold standard or historical practice? Am J Obstet Gynecol. 2008;199(6):625–6.

    PubMed  Google Scholar 

  51. Morris RK, Riley RD, Doug M, Deeks JJ, Kilby MD. Diagnostic accuracy of spot urinary protein and albumin to creatinine ratios for detection of significant proteinuria or adverse pregnancy outcome in patients with suspected pre-eclampsia: systematic review and meta-analysis. BMJ. 2012;345:e4342. The protein:creatinine ratio is an evidence-based, and easier to use, alternative to 24-h urine collection for the detection of significant proteinuria in pregnancy.

    CAS  PubMed  PubMed Central  Google Scholar 

  52. De Silva DA, Halstead AC, Cote AM, Sabr Y, von Dadelszen P, Magee LA. Unexpected random urinary protein:creatinine ratio results–limitations of the pyrocatechol violet-dye method. BMC Pregnancy Childbirth. 2013;13(1):152. Dilute urines can lead to false-positive protein estimations depending on the laboratory method being employed.

    PubMed  PubMed Central  Google Scholar 

  53. De Silva DA, Halstead AC, Cote AM, Sabr Y, von Dadelszen P, Magee LA. Random urine albumin:creatinine ratio in high-risk pregnancy - is it clinically useful? Pregnancy Hypertens. 2013;3:112–4.

    PubMed  Google Scholar 

  54. Payne B, Magee LA, Cote AM, Hutcheon JA, Li J, Kyle PM, et al. PIERS proteinuria: relationship with adverse maternal and perinatal outcome. J Obstet Gynaecol Can. 2011;33(6):588–97.

    PubMed  Google Scholar 

  55. Lindheimer MD, Kanter D. Interpreting abnormal proteinuria in pregnancy: the need for a more pathophysiological approach. Obstet Gynecol. 2010;115(2 Pt 1):365–75.

    CAS  PubMed  Google Scholar 

  56. Dunsmuir DT, Payne BA, Cloete G, Petersen CL, Gorges M, Lim J, et al. Development of mHealth applications for pre-eclampsia triage. J Biomed Health Inform. 2014. doi:10.1109/JBHI.2014.2301156. The miniPIERS model has been transferred to a mobile health application with associated evidence-based decision algorithms to guide care at the community level in less developed countries.

    PubMed  Google Scholar 

  57. Millman AL, Payne B, Qu Z, Douglas MJ, Hutcheon JA, Lee T, et al. Oxygen saturation as a predictor of adverse maternal outcomes in women with preeclampsia. J Obstet Gynaecol Can. 2011;33(7):705–14.

    PubMed  Google Scholar 

  58. Laskin S, Payne B, Hutcheon JA, Qu Z, Douglas MJ, Ford J, et al. The role of platelet counts in the assessment of inpatient women with preeclampsia. J Obstet Gynaecol Can. 2011;33(9):900–8.

    PubMed  Google Scholar 

  59. Bramham K, Poli-de-Figueiredo CE, Seed PT, Briley AL, Poston L, Shennan AH, et al. Association of proteinuria threshold in pre-eclampsia with maternal and perinatal outcomes: a nested case control cohort of high risk women. PLoS One. 2013;8(10):e76083. The threshold of 300 mg proteinuria/day identifies a group of women at incremental risk for adverse outcomes. Heavier proteinuria does not increase maternal, but may increase fetal, risks.

    CAS  PubMed  PubMed Central  Google Scholar 

  60. Gomez-Arriaga PI, Herraiz I, Lopez-Jimenez EA, Escribano D, Denk B, Galindo A. Uterine artery Doppler and sFlt-1/PlGF ratio: prognostic value in early-onset pre-eclampsia. Ultrasound Obstet Gynecol. 2014;43(5):525–32.

    Google Scholar 

  61. Gomez-Arriaga PI, Herraiz I, Lopez-Jimenez EA, Gomez-Montes E, Denk B, Galindo A. Uterine artery Doppler and sFlt-1/PlGF ratio: usefulness in diagnosis of pre-eclampsia. Ultrasound Obstet Gynecol. 2013;41(5):530–7.

    CAS  PubMed  Google Scholar 

  62. Ohkuchi A, Hirashima C, Suzuki H, Takahashi K, Yoshida M, Matsubara S, et al. Evaluation of a new and automated electrochemiluminescence immunoassay for plasma sFlt-1 and PlGF levels in women with preeclampsia. Hypertens Res. 2010;33(5):422–7.

    CAS  PubMed  Google Scholar 

  63. Schiettecatte J, Russcher H, Anckaert E, Mees M, Leeser B, Tirelli AS, et al. Multicenter evaluation of the first automated Elecsys sFlt-1 and PlGF assays in normal pregnancies and preeclampsia. Clin Biochem. 2010;43(9):768–70.

    CAS  PubMed  Google Scholar 

  64. Verlohren S, Herraiz I, Lapaire O, Schlembach D, Moertl M, Zeisler H, et al. The sFlt-1/PlGF ratio in different types of hypertensive pregnancy disorders and its prognostic potential in preeclamptic patients. Am J Obstet Gynecol. 2012;206(1):58.

    PubMed  Google Scholar 

  65. Gruslin A, Lemyre B. Pre-eclampsia: fetal assessment and neonatal outcomes. Best Pract Res Clin Obstet Gynaecol. 2011;25(4):491–507.

    PubMed  Google Scholar 

  66. Ebrashy A, Azmy O, Ibrahim M, Waly M, Edris A. Middle cerebral/umbilical artery resistance index ratio as sensitive parameter for fetal well-being and neonatal outcome in patients with preeclampsia: case–control study. Croat Med J. 2005;46(5):821–5.

    PubMed  Google Scholar 

  67. Payne BA, Kyle PM, Lisonkova S,Magee LA, Pullar B, Qu Z, et al. An assessment of predictive value of the biophysical profile in women with preeclampsia using data from the fullPIERS database. Pregnancy Hypertens. 2014. doi:10.1016/j.preghy.2013.03.001.

    Google Scholar 

  68. Kaur S, Picconi JL, Chadha R, Kruger M, Mari G. Biophysical profile in the treatment of intrauterine growth-restricted fetuses who weigh <1000 g. Am J Obstet Gynecol. 2008;199(3):264.

    PubMed  Google Scholar 

  69. Salvesen DR, Freeman J, Brudenell JM, Nicolaides KH. Prediction of fetal acidaemia in pregnancies complicated by maternal diabetes mellitus by biophysical profile scoring and fetal heart rate monitoring. Br J Obstet Gynaecol. 1993;100(3):227–33.

    CAS  PubMed  Google Scholar 

  70. Shalev E, Zalel Y, Weiner E. A comparison of the nonstress test, oxytocin challenge test, Doppler velocimetry and biophysical profile in predicting umbilical vein pH in growth-retarded fetuses. Int J Gynaecol Obstet. 1993;43(1):15–9.

    CAS  PubMed  Google Scholar 

  71. Koopmans CM, Bijlenga D, Groen H, Vijgen SM, Aarnoudse JG, Bekedam DJ, et al. Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia after 36 weeks’ gestation (HYPITAT): a multicentre, open-label randomised controlled trial. Lancet. 2009;374(9694):979–88.

    PubMed  Google Scholar 

  72. Broekhuijsen K, van Baaren G-J, van Pampus MG, Sikkema M, Woiski M, Oudijk M, et al. Delivery versus expectant monitoring for late preterm hypertensive disorders of pregnancy (HYPITAT-II): a multicenter, open label, randomized controlled trial [abstract]. Am J Obstet Gynecol. 2014;210(1):S2–3. The HYPITAT-II Trial informs us that a policy of expectant management of pregnancy hypertension in late preterm is preferable.

    Google Scholar 

  73. Churchill D, Duley L, Thornton JG, Jones L. Interventionist versus expectant care for severe pre-eclampsia between 24 and 34 weeks’ gestation. Cochrane Database Syst Rev. 2013;7, CD003106.

    Google Scholar 

  74. Magee LA, Yong PJ, Espinosa V, Cote AM, Chen I, von Dadelszen P. Expectant management of severe preeclampsia remote from term: a structured systematic review. Hypertens Pregnancy. 2009;28(3):312–47.

    CAS  PubMed  Google Scholar 

  75. Schutte JM, Schuitemaker NW, van Roosmalen J, Steegers EA. Substandard care in maternal mortality due to hypertensive disease in pregnancy in the Netherlands. BJOG. 2008;115(6):732–6.

    CAS  PubMed  Google Scholar 

  76. Gaugler-Senden IP, Huijssoon AG, Visser W, Steegers EA, De Groot CJ. Maternal and perinatal outcome of preeclampsia with an onset before 24 weeks’ gestation. Audit in a tertiary referral center. Eur J Obstet Gynecol Reprod Biol. 2006;128(1–2):216–21.

    PubMed  Google Scholar 

  77. Martin Jr JN, Thigpen BD, Moore RC, Rose CH, Cushman J, May W. Stroke and severe preeclampsia and eclampsia: a paradigm shift focusing on systolic blood pressure. Obstet Gynecol. 2005;105(2):246–54.

    PubMed  Google Scholar 

  78. Centre for Maternal and Child Enquiries (CMACE). Saving Mothers’ Lives: reviewing maternal deaths to make motherhood safer: 2006–08. The Eighth Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG. 2011;118(Suppl. 1):1–203.

  79. Lewis G. Saving mothers’ lives: reviewing maternal deaths to make motherhood safer. The 7th report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. London: Confidential Enquiry into Maternal and Child Health; 2007.

  80. Lalani S, Firoz T, Magee LA, Sawchuck D, Payne B, Gordon R, et al. Pharmacotherapy for preeclampsia in low and middle income countries: an analysis of essential medicines lists. J Obstet Gynaecol Can. 2013;35(3):215–23.

    PubMed  Google Scholar 

  81. Elatrous S, Nouira S, Ouanes BL, Marghli S, Boussarssar M, Sakkouhi M, et al. Short-term treatment of severe hypertension of pregnancy: prospective comparison of nicardipine and labetalol. Intensive Care Med. 2002;28(9):1281–6.

    CAS  PubMed  Google Scholar 

  82. Matsumura H, Takagi K, Seki H, Ono Y, Ichinose S, Masuko H, et al. Placental transfer of intravenous nicardipine and disposition into breast milk during the control of hypertension in women with pre-eclampsia. Hypertens Pregnancy. 2014;33(1):93–101.

    CAS  PubMed  Google Scholar 

  83. Nooij LS, Visser S, Meuleman T, Vos P, Roelofs R, De Groot CJ. The optimal treatment of severe hypertension in pregnancy update of the role of nicardipine. Curr Pharm Biotechnol. 2014.

  84. Peacock WF, Hilleman DE, Levy PD, Rhoney DH, Varon J. A systematic review of nicardipine vs labetalol for the management of hypertensive crises. Am J Emerg Med. 2012;30(6):981–93.

    PubMed  Google Scholar 

  85. Abalos E, Duley L, Steyn DW, Henderson-Smart DJ. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. Cochrane Database Syst Rev. 2007;1, CD002252.

    Google Scholar 

  86. Duley L, Gulmezoglu AM, Henderson-Smart DJ, Chou D. Magnesium sulphate and other anticonvulsants for women with pre-eclampsia. Cochrane Database Syst Rev. 2010;11, CD000025.

    Google Scholar 

  87. Duley L, Henderson-Smart DJ, Walker GJ, Chou D. Magnesium sulphate versus diazepam for eclampsia. Cochrane Database Syst Rev. 2010;12, CD000127.

    Google Scholar 

  88. Duley L, Henderson-Smart DJ, Chou D. Magnesium sulphate versus phenytoin for eclampsia. Cochrane Database Syst Rev. 2010;10, CD000128.

    Google Scholar 

  89. Duley L, Gulmezoglu AM, Chou D. Magnesium sulphate versus lytic cocktail for eclampsia. Cochrane Database Syst Rev. 2010;9, CD002960.

    Google Scholar 

  90. Duley L, Matar HE, Almerie MQ, Hall DR. Alternative magnesium sulphate regimens for women with pre-eclampsia and eclampsia. Cochrane Database Syst Rev. 2010;8, CD007388.

    Google Scholar 

  91. Gordon R, Magee LA, Payne B, Firoz T, Sawchuck D, Tu D, et al. Magnesium sulphate for the management of preeclampsia and eclampsia in low and middle income countries: a systematic review of tested dosing regimens. J Obstet Gynaecol Can. 2014;36(2):154–63.

    PubMed  Google Scholar 

  92. Bickford CD, Magee LA, Mitton C, Kruse M, Synnes AR, Sawchuck D, et al. Magnesium sulphate for fetal neuroprotection: a cost-effectiveness analysis. BMC Health Serv Res. 2013;13:527.

    PubMed  PubMed Central  Google Scholar 

  93. Cahill AG, Odibo AO, Stout MJ, Grobman WA, Macones GA, Caughey AB. Magnesium sulfate therapy for the prevention of cerebral palsy in preterm infants: a decision-analytic and economic analysis. Am J Obstet Gynecol. 2011;205(6):542–7.

    PubMed  Google Scholar 

  94. Magee L, Sawchuck D, Synnes A, von Dadelszen P. SOGC Clinical Practice Guideline. Magnesium sulphate for fetal neuroprotection. J Obstet Gynaecol Can. 2011;33(5):516–29.

    PubMed  Google Scholar 

  95. Firoz T, Melnik T. Postpartum evaluation and long term implications. Best Pract Res Clin Obstet Gynaecol. 2011;25(4):549–61.

    PubMed  Google Scholar 

  96. Ray JG, Vermeulen MJ, Schull MJ, Redelmeier DA. Cardiovascular health after maternal placental syndromes (CHAMPS): population-based retrospective cohort study. Lancet. 2005;366(9499):1797–803.

    PubMed  Google Scholar 

  97. Ray JG, Schull MJ, Kingdom JC, Vermeulen MJ. Heart failure and dysrhythmias after maternal placental syndromes: HAD MPS Study. Heart. 2012;98(15):1136–41.

    PubMed  Google Scholar 

  98. Williams D. Pregnancy: a stress test for life. Curr Opin Obstet Gynecol. 2003;15(6):465–71.

    PubMed  Google Scholar 

  99. Vikse BE, Irgens LM, Bostad L, Iversen BM. Adverse perinatal outcome and later kidney biopsy in the mother. J Am Soc Nephrol. 2006;17(3):837–45.

    PubMed  Google Scholar 

  100. Kestenbaum B, Seliger SL, Easterling TR, Gillen DL, Critchlow CW, Stehman-Breen CO, et al. Cardiovascular and thromboembolic events following hypertensive pregnancy. Am J Kidney Dis. 2003;42(5):982–9.

    PubMed  Google Scholar 

  101. Pell JP, Smith GC, Walsh D. Pregnancy complications and subsequent maternal cerebrovascular events: a retrospective cohort study of 119,668 births. Am J Epidemiol. 2004;159(4):336–42.

    PubMed  Google Scholar 

  102. Smith GC, Pell JP, Walsh D. Pregnancy complications and maternal risk of ischaemic heart disease: a retrospective cohort study of 129,290 births. Lancet. 2001;357(9273):2002–6.

    CAS  PubMed  Google Scholar 

  103. van Walraven C, Mamdani M, Cohn A, Katib Y, Walker M, Rodger MA. Risk of subsequent thromboembolism for patients with pre-eclampsia. BMJ. 2003;326(7393):791–2.

    PubMed  PubMed Central  Google Scholar 

  104. Bar J, Kaplan B, Wittenberg C, Erman A, Boner G, Ben-Rafael Z, et al. Microalbuminuria after pregnancy complicated by pre-eclampsia. Nephrol Dial Transplant. 1999;14(5):1129–32.

    CAS  PubMed  Google Scholar 

  105. Shammas AG, Maayah JF. Hypertension and its relation to renal function 10 years after pregnancy complicated by pre-eclampsia and pregnancy induced hypertension. Saudi Med J. 2000;21(2):190–2.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

Peter von Dadelszen and Laura Magee receive salary support from the Child and Family Research Institute (both), the University of British Columbia (PvD) and BC Women’s Hospital and Health Centre (LAM). Professor James Walker (UK) first presented the data shown in the figure to us. PRE-EMPT is funded by the University of British Columbia, a grantee of the Bill & Melinda Gates Foundation and the fullPIERS project and CHIPS Trial by the Canadian Institutes of Health Research.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, University of British Columbia, Rm V3-339, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada

    Peter von Dadelszen & Laura A. Magee

  2. Department of Medicine, University of British Columbia, Rm V3-339, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada

    Laura A. Magee

  3. The Child and Family Research Institute, University of British Columbia, Rm V3-339, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada

    Peter von Dadelszen & Laura A. Magee

Authors
  1. Peter von Dadelszen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Laura A. Magee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peter von Dadelszen.

Ethics declarations

Conflict of Interest Peter von Dadelszen has received an unrestricted grant-in-aid to support PlGF-related research, particularly related to IUGR. He has also received consultancy fees from Alere International and payments from Christiana Healthcare for work in a DSMB related to an RCT of antibiotics for group B streptococcus in pregnancy. Dr. von Dadelszen receives salary support from the Child & Family Research Institute, UBC.

Laura A. Magee has received consultancy fees from Alere International and salary support from the Child & Family Research Institute, UBC, and from BC Women’s Hospital.

Human and Animal Rights and Informed Consent This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Hypertensive Emergencies

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

von Dadelszen, P., Magee, L.A. Pre-eclampsia: An Update. Curr Hypertens Rep 16, 454 (2014). https://doi.org/10.1007/s11906-014-0454-8

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11906-014-0454-8

Keywords

Search

Navigation