Preeclampsia trial peg risk factors for SGA neonates: celebrity trial data also show chemical addition aspects

LISBON -- Smoking, high blood pressure, advanced protective age, history of preeclampsia, and lack of folate supplementation adjectives boosted the risk of small-for-gestational-age neonates, based on notes collected in the Vitamins in Preeclampsia trial.

Another alien analysis of results from this landmark trial showed that several of the risk factor for preeclampsia were stabilizer, producing risks in some women of more than 30%, Dr. Andrew H. Shennan said at the 15th World Congress of the International Society for the Study of Hypertension in Pregnancy.

The Vitamins in Preeclampsia (VIP) trial assessed the impact of daily supplements of vitamins C and E in a study next to about 2,400 pregnant women at 14-21 weeks gestational age who be at high risk for developing preeclampsia. Although the incidence of preeclampsia be the primary end point, a lesser analysis looked at the incidence of small-for-gestational-age (SGA) newborns. The primary outcome showed no benefit from these vitamin supplements on preeclampsia rates.

The overall incidence of neonates who be SGA at less than the 10th percentile be about 27% (Lancet, 2006;367:1145-54).

However, a more detailed analysis showed that the risk of SGA miscellaneous by 5- to 10-fold depending on whether the mother had one or more of five risk factor: smoking status, systolic blood pressure, history of preeclampsia, age, and folate supplementation, said Dr. Shennan, a professor of obstetrics at King's College, London.

The age cutoff for defining a higher-risk group was 35. Systolic blood pressure be divided into three risk levels. The lowest be women with pressures of 105 mm Hg or smaller number. Medium risk was a pressure of 110-130 mm Hg, and dignified risk was defined as a pressure of 135 mm Hg or more.

At one extreme for these risk factor were women who be nonsmokers or ex-smokers, younger than 35, with no history of rash preeclampsia, who had a systolic pressure at entry of 105 mm Hg or smaller number, and who used folate starting prepregnancy. Their risk for an SGA birth was 5%-10%.

At the other extreme be women who smoked, were 35 or elder, had a systolic pressure of 135 mm Hg or greater, have a history of early preeclampsia (occurring beforehand 37 weeks), and had unfamiliar folate supplementation. Their risk for an SGA birth was 55%-60%.

Dr. Shennan stressed that adjectives women in celebrity were enrol because they had at lowest one risk factor for preeclampsia, and hence the SGA incidence rates apply only to similarly high-risk women. The enrollment risk factor were a history of chronic hypertension or hypertension at presentation; a body mass index (BMI) of at least possible 30 kg/[m.sup.2]; a history of preeclampsia, eclampsia, or HELLP syndrome (hemodialysis, elevated liver enzymes, and low platelets); a multiple pregnancy; diabetes; abnormal uterine artery waveform; chronic renal disease; and antiphospholipid syndrome.

Another analysis reported by Dr. Shennan looked at how three of these risk factor interacted to affect the rate of preeclampsia. In the entire study, the overall rate of preeclampsia was 15%.

The focus of the subanalysis be the 1,344 women who were enrol with chronic hypertension, diabetes, or a soaring BMI. In this group, 1,156 women had newly one of these risk factors, 179 women have two of the risk factors, and 9 women have all three.

Among those next to one risk factor, the incidence of preeclampsia ranged from 7% to 10%. In women beside two risk factors, the risks be roughly additive and range from 22% to 33%. (See table.) In a multivariate analysis, women with two or more of these risk factor were in the order of twice as likely to develop preeclampsia as be women with one of these three risk factor, Dr. Shennan said.

BY MITCHEL L. ZOLER

Philadelphia Bureau

Additive Effects From Preeclampsia Risk Factors in the grandee Trial

Risk Factor Preeclampsia Incidence

Body mass index 30 kg/[m.sup.2] or greater 7%
Diabetes 13%
Chronic hypertension 18%
Chronic hypertension and high BMI 22%
High BMI and diabetes 26%
Chronic hypertension and diabetes 33%