Preeclampsia in 2023: Time for preventing early onset- and term preeclampsia: The paramount role of gestational weight gain

J Reprod Immunol. 2023 Aug:158:103968. doi: 10.1016/j.jri.2023.103968. Epub 2023 May 23.

Abstract

The 2023 goal is to halve the incidence of preeclampsia worldwide to reach 3 million cases per year vs the current approximately 7 million cases. Preventive treatment by low dose aspirin only halves the incidence of early-onset preeclampsia (EOP < 34 weeks gestation) in high-risk women. However, 90% of PE cases are the late onset form (LOP, 34 weeks onward) proportionally associated with increasing maternal pre-pregnancy BMI. In 2018, we published a new method to calculate individualized optimal gestational weight gain based on normal Gaussian distribution of neonatal birthweights (SGA 10%, LGA 10%) and demonstrated that this optimal gestational weight gain (GWG) follows a linear equation suitable for all maternal PRE-pregnancy BMIs (from lean to obesities classes 1-2-3). A similar linear equation has been published recently based on a 2022 US database of 200,000 multiple pregnancies. Subsequently, we demonstrated in a prospective population study that in overweight and obese women who are able to achieve an optimal GWG, the rate of term preeclampsia (> 37 week's gestation) halves. Providing individual app-based calculations of optimal individual GWG, all patients will be aware of their personal weight gain target over the pregnancy. CONCLUSION: Halving the incidence of early-onset- and term preeclampsia worldwide by prevention is now theoretically achievable. Appropriate and timely start of low-dose Aspirin and providing women clear advice on their optimal GWG are they ingredients to achieve this goal.

Keywords: Epidemiology; Gestational weight gain; Immunology; Late onset preeclampsia; Preeclampsia.

Publication types

  • Review

MeSH terms

  • Aspirin / therapeutic use
  • Body Mass Index
  • Female
  • Gestational Weight Gain*
  • Humans
  • Infant, Newborn
  • Obesity
  • Pre-Eclampsia* / epidemiology
  • Pre-Eclampsia* / etiology
  • Pre-Eclampsia* / prevention & control
  • Pregnancy
  • Pregnancy Outcome / epidemiology
  • Prospective Studies
  • Weight Gain

Substances

  • Aspirin