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

BMJ 2005; 330 doi: (Published 10 March 2005) Cite this as: BMJ 2005;330:565
  1. Kirsten Duckitt (Kduckitt{at}, consultant obstetrician1,
  2. Deborah Harrington, subspecialty trainee in maternal and fetal medicine1
  1. 1 Department of Obstetrics and Gynaecology, John Radcliffe Hospital, Oxford OX3 9DU
  1. Correspondence to: K Duckitt
  • Accepted 27 January 2005


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.


  • Contributors The original idea for the article came from a meeting of the PRECOG (pre-eclampsia community guideline) development group. The study was designed by KD. Data were extracted independently by KD and DH. The paper was written by KD and reviewed by DH. KD is guarantor.

  • Funding The photocopying of some of the articles was paid for by the charity APEC (Action on Pre-eclampsia).

  • Competing interests None declared.

  • Ethical approval Not needed.

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