Validation of the 34th week gestation as definition of late onset preeclampsia: Testing different cut-offs from 30 to 37 weeks on a population-based cohort of 1700 pre-eclamptics.
2020
INTRODUCTION: Early onset preeclampsia (EOP) and late onset preeclampsia (LOP) have been differentiated with a cut point of =34 weeks. This classical definition has never been examined with respect to maternal characteristics by different gestational age cut points. We examined maternal characteristics in a population based cohort of 1,736 preeclamptic deliveries at different gestational age cut points from 30 to 37 weeks (CO30 to CO37). MATERIAL AND METHODS: Eighteen year-observational population-based historical cohort study (2001-2018). All consecutive births delivered at the Centre Hospitalier Universitaire Hospitalier Sud Reunion's maternity. Standardized epidemiological perinatal data base. RESULTS: (a) Maternal ages: The incidence of EOP was lower in adolescents (1.8% vs 3.5%, OR 0.50, P = .17). Conversely, the odds of LOP was increased for women over 35, beginning at C030 (OR 1.13, P = .02) and this effect (OR = 1.2) was still detectable at C037 (P = .06). (b) Primigravidity: Among primigravid women, the incidence of EOP was lower than LOP (OR ranging from 0.71 to 0.82 for different CO). Conversely, the incidence of LOP was higher (adjusted OR about 2.7 (CO30 to CO34) with a rise to 3.3 at CO37 (P < .001). (c) Maternal BMI: Women with EOP had a lower BMI as compared to LOP at CO34 and CO37. The adjusted OR (per 5 BMI unit) declined from 1.06 to 1.03 from CO30 to C037 in EOP women. Conversely, for LOP: adjusted odds ratio (aOR) increased from 1.04 to 1.06 from CO30 to CO37 (P < .001). (d) Gestational diabetes mellitus was not associated with LOP at all cut-offs (aOR = 1.07, NS), but was protective against EOP from CO30 to CO34 (aOR 0.42, 0.61, 0.73 respectively, P < .001). This protective effect disappeared at CO37. 5) Chronic hypertension and history of preeclampsia were both EOP and LOP risks but with a much stronger effect for EOP (chronic hypertension: aOR = 6.0-6.5, history of preeclampsia: aOR = 12-17). CONCLUSIONS: The 34th week of gestation appears to provide a reasonable cut point to differentiate between EOP and LOP. Additional research is needed to better describe the possible differences in the pathophysiology of these different phenotypes.
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