Risk factors for pre-eclampsia in a large cohort of Latin American and Caribbean women

Objective: To study risk factors for pre-eclampsia in a large cohort of Latin American and Caribbean women. Design: Retrospective cross-sectional study from the Perinatal Information System, the database of the Latin American Center for Perinatology and Human Development, Montevideo, Uruguay. Setting: Latin America and the Caribbean, 1985-1997. Population: 878,680 pregnancies at 700 hospitals; of these 42,530 were complicated by pre-eclampsia and 1872 by eclampsia. Main outcome measures: Crude and adjusted relative risks (RR) of risk factors for pre-eclampsia. Adjusted relative risks were obtained after adjustment for potential confounding factors through multiple logistic regression models based on the method of generalised estimating equations. Results: The following risk factors were significantly associated with increased risk of pre-eclampsia: nulliparity (RR 2.38; 95% CI 2.28-2.49); multiple pregnancy (RR 2.10; 95% CI 1.90-2.32); history of chronic hypertension (RR 1.99; 95% CI 1.78-2.22); gestational diabetes mellitus (RR 1.93; 95% CI 1.66-2.25); maternal age greater than or equal to 35 years (RR 1.67; 95% CI 1.58-1.77); fetal malformation (RR 1.26; 95% CI 1.16-1.37); and mother not living with infant's father (RR 1.21; 95% CI 1.15-1.26). Preeclampsia risk increased according to pre-pregnancy body mass index (BMI). In comparison with women with a normal pre-pregnancy BMI (19.8 to 26.0), the RR estimates were 1.57 (95% CI 1.49-1.64) and 2.81 95% CI 2.69-2.94), respectively, for overweight women (pre-pregnancy BMI = 26.1 to 29.0) and obese women (pre-pregnancy BMI > 29.0). Cigarette smoking during pregnancy and a pre-pregnancy BMI < 19.8 were significant protective factors against the development of preeclampsia. The pattern of risk factors among nulliparous and multiparous women was quite similar. Conclusions: Risk factors for pre-eclampsia observed among Latin American and Caribbean women are similar to those found among North American and European women.