Key Takeaways
- Preeclampsia affects 2-8% of pregnancies globally, with higher rates in developing countries.
- In the United States, about 4% of pregnancies are affected by preeclampsia each year.
- Incidence of preeclampsia in first pregnancies is approximately 3.4%.
- Maternal age >35 years increases risk by 1.5-2 fold.
- Nulliparity raises preeclampsia risk 2-3 times.
- Obesity (BMI ≥30) triples preeclampsia risk.
- Preeclampsia symptoms include new-onset hypertension after 20 weeks with proteinuria ≥300mg/24h.
- Severe features: systolic BP ≥160 mmHg or diastolic ≥110 mmHg on two occasions.
- Proteinuria defined as ≥300 mg per 24-hour urine collection or protein/creatinine ratio ≥0.3.
- Magnesium sulfate prevents 50% of eclampsia seizures.
- Delivery is definitive treatment after 34 weeks.
- Expectant management <34 weeks if stable: prolongs pregnancy by 1-2 weeks.
- Preeclampsia increases maternal stroke risk 5-fold long-term.
- Perinatal mortality 5-10 times higher with preeclampsia.
- Preterm birth <37 weeks in 25-50% of cases.
Preeclampsia is a dangerous pregnancy complication affecting millions of women worldwide each year.
Clinical Features
- Preeclampsia symptoms include new-onset hypertension after 20 weeks with proteinuria ≥300mg/24h.
- Severe features: systolic BP ≥160 mmHg or diastolic ≥110 mmHg on two occasions.
- Proteinuria defined as ≥300 mg per 24-hour urine collection or protein/creatinine ratio ≥0.3.
- HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) in 10-20% of severe cases.
- Headache persisting despite analgesics is a severe feature.
- Visual disturbances like scotoma occur in 25% of severe preeclampsia.
- Epigastric or right upper quadrant pain in 40-50% of severe cases.
- Pulmonary edema present in 2-3% of preeclampsia cases.
- Thrombocytopenia <100,000/μL indicates severity.
- Elevated creatinine >1.1 mg/dL or doubling baseline is severe.
- Liver enzymes >2x upper limit in 20% severe preeclampsia.
- Fetal growth restriction in 25-30% of preeclampsia pregnancies.
- Oligohydramnios seen in 15-20% cases.
- Placental abruption risk 10 times higher.
- Diagnosis without proteinuria if new thrombocytopenia, renal insufficiency, etc.
- Edema in 80% but not diagnostic.
- Hyperreflexia with clonus in severe disease.
- Retinal changes like arteriolar narrowing on fundoscopy.
- Urine dipstick ≥2+ protein correlates with ≥300mg/24h in 90%.
- Mean arterial pressure >140 mmHg prompts evaluation.
- Uric acid >5.5 mg/dL supports diagnosis.
- sFlt-1/PlGF ratio >38 indicates high risk.
- Ultrasound Doppler: absent end-diastolic flow in 15%.
- Eclampsia seizures in 1-2% of preeclampsia cases.
Clinical Features Interpretation
Epidemiology
- Preeclampsia affects 2-8% of pregnancies globally, with higher rates in developing countries.
- In the United States, about 4% of pregnancies are affected by preeclampsia each year.
- Incidence of preeclampsia in first pregnancies is approximately 3.4%.
- Severe preeclampsia occurs in 0.5-1% of all pregnancies worldwide.
- Preeclampsia accounts for 14% of maternal deaths globally.
- In low-income countries, preeclampsia/eclampsia causes 10-15% of maternal mortality.
- Prevalence of preeclampsia in twin pregnancies is 10-20%.
- Nulliparous women have a 5-6% risk of developing preeclampsia.
- Preeclampsia recurs in 20-40% of subsequent pregnancies.
- Early-onset preeclampsia (<34 weeks) occurs in 0.38% of pregnancies.
- Late-onset preeclampsia (≥34 weeks) affects 2.31% of pregnancies.
- Global burden: 10 million women affected by preeclampsia annually.
- In Africa, preeclampsia incidence is up to 10%.
- Hispanic women in the US have a 5.5% preeclampsia rate.
- Non-Hispanic black women have 1.5 times higher preeclampsia risk than whites.
- Age >40 years increases preeclampsia risk to 10-15%.
- Preeclampsia superimposed on chronic hypertension affects 25-40%.
- IVF pregnancies have 1.5-2 times higher preeclampsia incidence.
- In Australia, preeclampsia affects 1 in 50 pregnancies.
- UK preeclampsia prevalence is 5.6%.
- Brazil reports 8-10% preeclampsia rate in public health system.
- India has preeclampsia incidence of 8-10%.
- China preeclampsia rate is 4.1%.
- Canada reports 3.7% preeclampsia prevalence.
- Europe average preeclampsia incidence 2-5%.
- Preeclampsia in adolescents <20 years: 4.8%.
- Women 35-39 years: 7.2% preeclampsia risk.
- ≥40 years: 11.1% preeclampsia incidence.
- First birth after 30 years doubles preeclampsia risk.
- Preeclampsia/eclampsia responsible for 50,000 maternal deaths yearly worldwide.
Epidemiology Interpretation
Management
- Magnesium sulfate prevents 50% of eclampsia seizures.
- Delivery is definitive treatment after 34 weeks.
- Expectant management <34 weeks if stable: prolongs pregnancy by 1-2 weeks.
- Antihypertensives: labetalol, nifedipine, hydralazine for BP ≥160/110.
- Low-dose aspirin 81-150mg from 12 weeks reduces risk by 10-24% in high-risk.
- Calcium supplementation 1-2g/day reduces risk 35% in low-intake populations.
- Bed rest not recommended; ambulatory management preferred.
- Fetal monitoring: NST twice weekly <32 weeks.
- Biophysical profile weekly after 32 weeks.
- Corticosteroids for lung maturity if delivery <34 weeks.
- Magnesium loading dose 4-6g IV, maintenance 1-2g/h.
- Postpartum BP monitoring for 72 hours.
- Preeclampsia resolves within 48 hours postpartum in 90%.
- ACOG recommends screening high-risk with uterine artery Doppler.
- Remote monitoring of BP reduces hospitalizations by 20%.
- Lifestyle: weight loss pre-pregnancy reduces risk 20%.
- No role for diuretics routinely.
- Timing of delivery: 37 weeks for mild preeclampsia.
- Cesarean if unstable or <34 weeks with severe features.
- Prophylactic antibiotics for cesarean reduce endometritis.
- Postpartum thromboprophylaxis if indicated.
- Long-term CV risk: 2-4 fold increase post-preeclampsia.
Management Interpretation
Outcomes
- Preeclampsia increases maternal stroke risk 5-fold long-term.
- Perinatal mortality 5-10 times higher with preeclampsia.
- Preterm birth <37 weeks in 25-50% of cases.
- Intrauterine growth restriction (IUGR) in 28%.
- Stillbirth risk 4-fold increased.
- Neonatal ICU admission 3 times higher.
- Maternal mortality 0.4% in severe preeclampsia.
- Eclampsia mortality 1-2%.
- HELLP syndrome mortality 1-2%.
- Placental abruption in 5-10% severe cases.
- Pulmonary edema mortality up to 5%.
- Cerebral hemorrhage in eclampsia: 25% of fatalities.
- Offspring CV disease risk 2-fold later in life.
- Maternal diabetes risk doubles post-preeclampsia.
- Chronic hypertension develops in 15-50% within years.
- Renal failure risk 10 times higher long-term.
- Early-onset preeclampsia: 20% perinatal mortality.
- Late-onset: <5% perinatal mortality.
- Recurrent preeclampsia: worse outcomes in 30%.
- In developing countries, case fatality 5-15%.
- US maternal mortality from preeclampsia: 70 per 100,000 cases.
- Fetal death rate 1.3% in preeclampsia.
- Neonatal mortality 0.6-1.2%.
- Long-term neurodevelopmental issues in 10-15% offspring.
- Maternal mortality ratio from preeclampsia/eclampsia: 16% of direct causes.
- In high-resource settings, maternal mortality <0.1%.
Outcomes Interpretation
Risk Factors
- Maternal age >35 years increases risk by 1.5-2 fold.
- Nulliparity raises preeclampsia risk 2-3 times.
- Obesity (BMI ≥30) triples preeclampsia risk.
- Chronic hypertension multiplies risk by 5-10 times.
- Diabetes (pregestational) increases risk 4-fold.
- Multiple gestation doubles to quadruples risk.
- Family history of preeclampsia raises risk 2-4 times.
- Black race/ethnicity has 1.5-2 times higher risk.
- Previous preeclampsia history: 15-20% recurrence risk.
- Autoimmune diseases like lupus raise risk 5-10 times.
- Smoking decreases preeclampsia risk by 20-30%.
- Partner with previous preeclamptic pregnancy: 2-fold risk increase.
- Short interpregnancy interval (<2 years) increases risk 1.5 times.
- Assisted reproductive technology (ART) pregnancies: 1.75 relative risk.
- Gestational diabetes adds 1.5-2 fold risk.
- Renal disease history: 20-30% preeclampsia incidence.
- Thrombophilias (e.g., factor V Leiden) increase risk 1.5-2 times.
- High altitude living (>2500m) doubles risk.
- Low socioeconomic status correlates with 1.5 times higher risk.
- BMI 25-29.9: 1.7 relative risk for preeclampsia.
- BMI ≥35: 4.2 relative risk.
- Antiphospholipid syndrome: 40-50% risk.
- Prior fetal growth restriction: 2-3 fold risk.
- Hydrops fetalis history increases risk.
- Interleukin-6 gene polymorphism raises risk 2-fold.
Risk Factors Interpretation
Sources & References
- Reference 1WHOwho.intVisit source
- Reference 2CDCcdc.govVisit source
- Reference 3PUBMEDpubmed.ncbi.nlm.nih.govVisit source
- Reference 4NCBIncbi.nlm.nih.govVisit source
- Reference 5THELANCETthelancet.comVisit source
- Reference 6ACOGacog.orgVisit source
- Reference 7AIHWaihw.gov.auVisit source
- Reference 8NPEUnpeu.ox.ac.ukVisit source
- Reference 9CANADAcanada.caVisit source






