Poster Presentation Society of Obstetric Medicine of Australia and New Zealand ASM 2015

Is recent infection associated with preeclampsia onset? (#204)

J B Ford 1 2 , K Schemann 1 2 , R M Herbert 3 , J A Patterson 1 2 , C L Roberts 1 2 , J M Morris 2
  1. Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia
  2. Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia
  3. Biostatistics Training Program, NSW Ministry of Health, Sydney, New South Wales, Australia

Background: Risk factors for preeclampsia are well established; triggers associated with gestational age of onset are not. The aim of this study was to establish whether preeclampsia gestation of onset is associated with a recent infection or other triggers.

Methods: We used a case-crossover design in which preeclampsia cases served as their own controls and each woman contributed one case window and one control window period.  The case window included the 1-7 days preceding preeclampsia diagnosis; the control window included the 8-14 days prior. Women with singleton pregnancies of ≥20 weeks gestation, diagnosed with proteinuric preeclampsia at 3 metropolitan hospitals were eligible. Triggers were investigated via guided questionnaire; preeclampsia severity was identified through medical record review. Proteinuric preeclampsia was defined as hypertension (systolic BP ≥140 mmHg and/or diastolic ≥90 mmHg) and proteinuria (≥300mg/ 24 hr or spot using protein/creatinine ratio ≥30 mg/ mmol). Infections included any episode of symptoms lasting > 24 hours that was perceived by the woman as an infection. Conditional logistic regression was used to analyse discordant pairs; unadjusted odds ratios (ORs) are reported.

Results: Among 284 women recruited to the study, 25 (8.7%) had a new infection in the 7 days prior to preeclampsia onset and 21 (7.3%) in the 8-14 days prior (Table).  There was no statistically significant association between onset of infection in the 7 days prior and preeclampsia diagnosis (OR 1.24, CI 0.65-2.34). Consumption of caffeine (OR 0.51, CI 0.33-0.77), spicy food (0.49, CI 0.30-0.81) and alcohol (0.26, CI 0.10-0.71) were inversely associated with preeclampsia onset with fewer exposures in the case than control window. No other triggers were associated with preeclampsia onset.Conclusion: Onset of new infection in the 7 days prior does not appear to be associated with timing of preeclampsia onset. Decreased consumption of caffeine, spicy food and alcohol may be prodomal markers. Changes in such behaviour may be an early marker to initiate further clinical investigation.

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