BMJ  2005;330:565 (12 March), doi:10.1136/bmj.38380.674340.E0 (published 2 March 2005)

Paper

Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies

¹ Department of Obstetrics and Gynaecology, John Radcliffe Hospital, Oxford OX3 9DU

Objective To determine the risk of pre-eclampsia associated with factors that may be present at antenatal booking.

Design Systematic review of controlled studies published 1966-2002.

Data synthesis Unadjusted relative risks were calculated from published data.

Results Controlled cohort studies showed that the risk of pre-eclampsia is increased in women with a previous history of pre-eclampsia (relative risk 7.19, 95% confidence interval 5.85 to 8.83) and in those with antiphospholipids antibodies (9.72, 4.34 to 21.75), pre-existing diabetes (3.56, 2.54 to 4.99), multiple (twin) pregnancy (2.93, 2.04 to 4.21), nulliparity (2.91, 1.28 to 6.61), family history (2.90, 1.70 to 4.93), raised blood pressure (diastolic 80 mm Hg) at booking (1.38, 1.01 to 1.87), raised body mass index before pregnancy (2.47, 1.66 to 3.67) or at booking (1.55, 1.28 to 1.88), or maternal age 40 (1.96, 1.34 to 2.87, for multiparous women). Individual studies show that risk is also increased with an interval of 10 years or more since a previous pregnancy, autoimmune disease, renal disease, and chronic hypertension.

Conclusions These factors and the underlying evidence base can be used to assess risk at booking so that a suitable surveillance routine to detect pre-eclampsia can be planned for the rest of the pregnancy.

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