Preeclampsia is associated with increased maternal body weight in a northeastern Brazilian population.

BACKGROUND: Preeclampsia is a disease with great variability in incidence across the world. The mortality is higher in lower income countries, where it is the leading cause of maternal mortality. This study aimed to determine the frequency of and risk factors for preeclampsia in a low income population from an urban area of Brazil. METHODS: A prospective case control study of 242 women of which 30 developed preeclampsia, 4 had gestational hypertension, 2 had superimposed hypertension, 11 had spontaneous abortion, 13 were lost to follow up and 192 had normal pregnancy. This latter group was considered the normotensive controls. The rate of preeclampsia and the risk of cardiovascular disease, after onset of preeclampsia, were determined. RESULTS: Of the 218 women who completed the study, the frequency of hypertensive disorder of pregnancy was 16.5% (36 of 218) and of preeclampsia was 13.8% (30 of 218). Women with preeclampsia had a higher body mass index (BMI), mean of 25.3 ± 4.8 compared to 23.5 ± 3.7 for the normotensive controls, p = 0.02. The risk of preeclampsia increased with BMI [Odds ratio (OR) 1.12, 95% Confidence Interval (CI = 1.02;1.24, p-value = 0.023)]. Women with preeclampsia developed chronic hypertension more often than normotensive controls (p = 0.043) and their systolic and ambulatory blood pressure monitoring was elevated (p = 0.034). Women with preeclampsia had higher BMI even 5 years post-pregnancy (p = 0.008). CONCLUSIONS: Women who are overweight or older have an increased risk of preeclampsia. Previous history of preeclampsia increases the risk of early onset of chronic hypertension. Therefore, effective preventive measures are needed, particularly women at lower social economic stratum who have less access to proper medical care and adequate nutrition.

Síndrome HELLP: considerações acerca de diagnóstico e conduta / Hellp syndrome: considerations about diagnosis and management

A síndrome HELLP é uma grave complicação da pré-eclampsia, cursando com elevada morbimortalidade materna e perinatal. Controvérsias ocorrem com relação à incidência, critérios de diagnóstico e conduta nesta síndrome. As mortes perinatais estão relacionadas com o descolamento prematuro da placenta, asfixia intra-útero e prematuridade. A utilização de altas doses de corticóide no tratamento parece proporcionar melhores resultados maternos e perinatais, no entanto, são necessários estudos randomizados para sua completa e segura utilização na síndrome HELLP. O maior desafio diante desta síndrome é o diagnóstico precoce, intervenção oportuna e a prevenção das complicações. Sendo assim, as pacientes com suspeita de síndrome HELLP deverão ser encaminhadas para um serviço de assistência terciária para que sejam assistidas por uma equipe especializada, e tão logo possível, promova-se a interrupção da gestação.