Scheduled Childbirth May Reduce Risk of Preeclampsia

According to research published today in Hypertension, timed birth, such as a scheduled induction or Cesarean delivery, may prevent more than half of all preeclampsia cases that happen during weeks 37 to 42 of pregnancy (at-term).
Preeclampsia, the world’s largest cause of maternal death during pregnancy, is the most deadly form of high blood pressure (140/90 mm Hg). One in every 25 pregnancies in the US is affected by preeclampsia, which can be fatal. Usually, the problem is discovered after 20 weeks of pregnancy. For the mother, symptoms may include headaches, blurred vision, and swelling of the hands, feet, face, or eyes; for the baby, symptoms may include a change in well-being. Additionally, preeclampsia suggests a higher chance of getting heart disease for women later in life.

Preterm birth may be a possibility for women who develop preeclampsia between weeks 20 and 36 of pregnancy; however, the majority of preeclampsia cases occur between weeks 37 and 42 of pregnancy, which is referred to as at-term. Prenatal preeclampsia screening is common, but there are few safe and efficient treatment options available. Aspirin does not affect the risk of at-term preeclampsia, which is three times more common than preterm preeclampsia and linked with severe difficulties for mothers and newborns. Low-dose aspirin significantly reduces the risk of preterm preeclampsia among women at risk.
Timed birth methods, such as preplanned cesarean births and inducing labor, are already often used for a variety of causes. But they are rarely employed as interventions.

“Timed birth is achievable in many hospitals or health centers,” said lead study author Laura A. Magee, M.D., a professor of women’s health at King’s College in London, “so our proposed approach to preventing at-term preeclampsia has huge potential for global good in maternity care.”

Nearly 90,000 pregnancies at two hospitals in the United Kingdom (King’s College Hospital in London and Medway Maritime Hospital in Gillingham) were the subject of an analysis of more than ten years’ worth of health records. Between 2006 and 2017, there were 57,131 pregnancies with health records at 11 to 13 weeks, with 1,138 cases of at-term preeclampsia; and between 2016 and 2018, there were 29,035 pregnancies at 35 to 36 weeks, with 619 cases of at-term preeclampsia. Researchers used a risk prediction model and accepted clinical preeclampsia criteria to assess the risk of preeclampsia and the possible benefits of delayed birth for both groups. (a computer program that predicts the risk of preeclampsia based on various individual factors, such as maternal history, blood pressure, ultrasound, and blood tests).

The bulk of the women in the dataset self-identified as Caucasian, were in their early 30s, and had body mass indices that were over normal. Only 3.9% of the women in the analysis reported having a family history of preeclampsia, and 10% of the women in the study also self-reported smoking. Less than 3% of the women in the analysis had a medical history of high blood pressure, Type 2 diabetes, or an autoimmune condition.

Participants screened during the first trimester and those screened during the third trimester experienced at-term preeclampsia at comparable rates. Women in the study gave birth on average at 40 weeks, and two-thirds of all participants reported spontaneous labor. In the analysis, around one-fourth of the women gave birth via cesarean section.

The analysis indicates that, when utilizing risk modeling in place of standard clinical screening, timed birth may prove to be an effective intervention for reducing by more than half the risk of at-term preeclampsia.

“Our findings suggest that over half of the cases of at-term preeclampsia may be prevented by timed (planned) birth,” said Magee. “It is important to note that being at higher risk of at-term preeclampsia was associated with earlier spontaneous onset of labor, so women at the highest risk were already less likely to deliver close to their due date.”

The research had limitations in that no therapies were given to participants, and risk modeling was the only method used to estimate possible risk. Additionally, the study did not look at the possibility of postpartum preeclampsia. The researchers observed that despite being an observational study that used modeling to predict risk reduction for at-term preeclampsia, the study’s advantages included the sizeable population of women represented and the accessibility of labor induction and cesarean delivery. However, studies that randomly assign participants to receive treatment, no treatment, or a different treatment are required to assess the safety and efficacy of delayed birth as a suitable intervention to lower at-term preeclampsia.

The American Heart Association detailed the advantages of early interventions to support pre- and interpregnancy (during pregnancy) cardiovascular health in a scientific statement titled Optimizing Prepregnancy Cardiovascular Health to Improve Outcomes in Pregnant and Postpartum Individuals and Offspring in February 2023. The statement highlighted dietary, smoking cessation, and weight loss programs that may lessen the frequency of unfavorable pregnancy and delivery outcomes. (such as hypertensive disorders of pregnancy, pre-term birth, small-for-gestational-age birth, or gestational diabetes). To comprehend the connection between thorough cardiovascular health care throughout pregnancy and the incidence of unfavorable pregnancy outcomes, more research is required.

Co-authors are David Wright, Ph.D.; Argyro Syngelaki, Ph.D.; Peter von Dadelszen, D.Phil.; Ranjit Akolekar, M.D.; Alan Wright, Ph.D.; and Kypros H. Nicolaides, M.D.

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