Anamnestic predictors of preeclampsia risk: a modern view on the problem

Preeclampsia is a multisystemic syndrome that occurs exclusively during pregnancy and is one of the leading causes of maternal, fetal, and neonatal morbidity and mortality. The primary clinical manifestation of preeclampsia is hypertension, which develops de novo in the mother after the 20th week of gestation and is accompanied by proteinuria, uterine and placental complex dysfunction, and maternal organ involvement. Treatment of preeclampsia is symptomatic, with the only proven effective method being pregnancy termination – delivery, regardless of the gestational age. Despite that the various clinical and anamnestic factors are associated with an increased likelihood of preeclampsia, the most cases of hypertensive disorders during pregnancy occur in healthy women who are giving birth for the first time and have no other risk factors. This fact highlights the need to find new, more reliable criteria for predicting preeclampsia, especially in nulliparous women, to facilitate timely preventive measures and reduce the risk of perinatal complications for both the mother and the fetus.The objective: to investigate the relevance of key anamnestic predictors of the risk of developing preeclampsia in the local population of Ukrainian primigravida women based on clinical practice data.Materials and methods. The study was conducted at the clinical base of the Department of Obstetrics and Gynecology No. 3, Bogomolets National Medical University – communal non-profit enterprise “Kyiv City Maternity Hospital No. 3”.To achieve the stated goal, we first conducted a clinical and statistical audit, which included data from patients who underwent treatment and delivery in the Department of Pregnancy Pathology and the Physiological Obstetrics Department between 2018 and 2023. The focus was on maternal history data to determine the frequency and structure of hypertensive disorders (Form No. 113/o) and data from pregnancy and delivery cards (Form No. 096/o). A total of 1,098 cases of hypertensive disorders in pregnant women were selected and analyzed. At the next stage, a retrospective analysis of 140 prenatal cards of nulliparous women and pregnancy and delivery cards was conducted. The study included 88 cases of preeclampsia. For comparison, a control group was formed, consisting of 52 pregnancy and childbirth histories of nulliparous women with uncomplicated pregnancies and no hypertensive syndrome. Participants were randomly selected.Results. The frequency of hypertensive syndrome in the pregnant population increased from 8.3% in 2018 to 12.2% in 2023. Preeclampsia was more frequent in nulliparous women (10.1%), women with a history of chronic hypertension (5.4%), and in women who had used assisted reproductive technologies (3.8%). In the group of primiparous women with preeclampsia, young persons aged 20–25 years prevailed, also women with an early menarche onset before 11 years (p < 0.05) (odds ratio (OR) 1.96; 95% confidence interval [1.09–3.52]). Among women with preeclampsia, there was a significant predominance of somatic disorders, such as varicose veins (29.0%; OR 4.56; p < 0.05), cardiovascular system pathologies (19.4%; OR 2.76; p < 0.05), urinary system pathologies (17.7%; OR 4.00; p < 0.05), thyroid disorders (12.9%; OR 4.08; p < 0.05), overweight (24.2%; OR 2.32; p < 0.05), diabetes mellitus (6.5%; OR 3.48; p < 0.05), and a history of COVID-19 (41.9%; OR 1.83; p < 0.05). In the structure of gynecological pathology, inflammatory diseases of the female genital organs (42.1%; OR 3.03; p < 0.05), menstrual cycle disorders (32.9%; OR 1.41; p < 0.05), ovarian cysts (28.9%; OR 2.75; p < 0.05), polycystic ovary syndrome (18.4%; OR 2.11; p < 0.05), hyperproliferative endometrial diseases, including polyps (18.4%; OR 3.27; p < 0.05), and hyperplasia (11.8%; OR 4.02; p < 0.05) were predominant.Conclusions. The identified predictors should be considered in the clinical assessment of preeclampsia risk in primigravid women to ensure early detection and implementation of preventive measures.