Preeclampsia still ranks as one of obstetrics major problems. Clinicians typically encounter preeclampsia as a maternal disease with variable degrees of fetal involvement. More and more the unique immunogenetic maternal-paternal relationship is appreciated, and as such also the specific ‘genetic conflict’ that is characteristic of haemochorial placentation. From that perspective preeclampsia can also been seen as a disease of an individual couple with primarily maternal and fetal manifestations.
The frequency of preeclampsia is between 2-7% in healthy nulliparous women. In these women, the disease is mostly mild, the onset mostly near term or intrapartum (75% of cases), and only conveys a negligible increased risk for adverse pregnancy outcome. By contrast, frequency and severity of the disease are substantially higher in women with multifetal gestation, chronic hypertension, previous preeclampsia,, pre-gestational diabetes mellitus, and pre-existing thrombophilia’s.
The typical obstetric textbook often states that preeclampsia is a ‘primigravidity’ disorder. This is not correct. Preeclampsia is a disease of first pregnancy within a couple (primipaternity). A previous abortion (spontaneous or induced) or healthy pregnancy with the same partner is associated with a reduced risk of preeclampsia, although this protective effect is lost with a change of partner. The risk increases in those who have limited sperm exposure with the same partner before conception. Also, men who fathered one preeclamptic pregnancy are nearly twice as likely to father a preeclamptic pregnancy in a different woman, irrespective of whether she had already had a preeclamptic pregnancy or not. Current research focusses on the possible role of viral infections in the male genital tract to explain the ‘dangerous father concept’.