Department of Neonatology, Centre Hospitalier Universitaire Sud Réunion, Saint-Pierre Cedex, La Réunion.
Center for Perinatal Studies of the Indian Ocean (CEPOI), Centre Hospitalier Universitaire Sud Réunion, Saint-Pierre Cedex, La réunion.
Acta Obstet Gynecol Scand. 2020 Sep;99(9):1181-1190. doi: 10.1111/aogs.13846. Epub 2020 Apr 9.
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 1736 preeclamptic deliveries at different gestational age cut-points from 30 to 37 weeks (CO30 to CO37).
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 database.
The incidence of EOP was lower in adolescents (1.8% vs 3.5%, odds ratio [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). 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-CO34] with a rise to 3.3 at CO37 (P < .001). Women with EOP had a lower body mass index (BMI) as compared with LOP at CO34 and CO37. The adjusted OR (per 5 kg/m increment) declined from 1.06 to 1.03 from CO30 to C037 in EOP women. Conversely, for LOP, the adjusted odds ratio (aOR) increased from 1.04 to 1.06 from CO30 to CO37 (P < .001). Gestational diabetes mellitus was not associated with LOP at any cut-off (aOR 1.07, NS) but was protective against EOP from CO30 to CO34 (aOR 0.42, 0.61 and 0.73, respectively, P < .001). This protective effect disappeared at CO37. 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).
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.
早发型子痫前期（EOP）和晚发型子痫前期（LOP）的定义为≤34 周。然而，这种经典定义从未根据不同的妊娠周龄界限，针对产妇特征进行过检验。我们在一项基于人群的 1736 例子痫前期分娩队列中，以 30 至 37 周（CO30 至 CO37）的不同妊娠周龄界限进行了产妇特征检验。
18 年的观察性基于人群的历史队列研究（2001-2018 年）。所有连续分娩均在留尼汪圣但尼中心医院妇产科医院进行。标准化的流行病学围产期数据库。
青少年中 EOP 的发病率较低（1.8% vs 3.5%，比值比 [OR] 0.50，P =.17）。相反，35 岁以上妇女的 LOP 发病风险增加，从 C030 开始（OR 1.13，P =.02），这种影响（OR = 1.2）在 C037 仍然可检测到（P =.06）。在初产妇中，EOP 的发病率低于 LOP（不同 CO 的比值比范围为 0.71 至 0.82）。相反，LOP 的发病率更高（调整后的 OR 约为 2.7 [CO30-CO34]，在 CO37 上升至 3.3（P <.001）。与 LOP 相比，EOP 患者在 CO34 和 CO37 的体重指数（BMI）较低。EOP 患者的调整比值比（每增加 5kg/m2）从 CO30 到 C037 下降了 1.06 至 1.03。相反，对于 LOP，调整后的比值比（aOR）从 CO30 到 CO37 增加了 1.04 至 1.06（P <.001）。妊娠期糖尿病在任何界限均与 LOP 无关（aOR 1.07，无统计学意义），但在 CO30 至 CO34 期间对 EOP 有保护作用（aOR 0.42、0.61 和 0.73，均为 P <.001）。这种保护作用在 CO37 时消失。慢性高血压和子痫前期病史都是 EOP 和 LOP 的风险因素，但对 EOP 的影响更强（慢性高血压：aOR 6.0-6.5，子痫前期病史：aOR 12-17）。
34 周妊娠似乎是区分 EOP 和 LOP 的合理界限。需要进一步研究以更好地描述这些不同表型的病理生理学可能存在的差异。
