Incidence, risk factors, and associated complications of eclampsia.
OBJECTIVE
To estimate trends in incidence and identify risk factors and maternal and neonatal consequences of eclampsia in Canada.


METHODS
We conducted a population-based cohort study of all women and their newborns (N=1,910,729) delivered in the hospital in Canada (excluding Quebec) from 2003 to 2009. The data were obtained from the Canadian Institute for Health Information. Logistic models were used to examine the association with potential determinants and consequences of eclampsia.


RESULTS
The incidence of eclampsia declined dramatically from 12.4 per 10,000 deliveries in 2003 to 5.9 in 2009. Among singleton deliveries, nulliparity (adjusted odds ratio [OR] 2.3; 95% confidence interval [CI] 2.0-2.6), anemia (adjusted OR 2.4; 95% CI 2.0-3.0), and existing heart disease (adjusted OR 4.8; 95% CI 2.9-7.3) increased the risk of eclampsia. The declining trend in eclampsia remained unchanged after accounting for changes in potential determinants and risk factors during the study period. Eclampsia was associated with increased risks of maternal death (adjusted OR 26.8; 95% CI 9.7-73.8), assisted ventilation (adjusted OR 102.3; 95% CI 78.2-133.8), respiratory distress syndrome (adjusted OR 36.2; 95% CI 15.3-85.3), acute renal failure (adjusted OR 20.9; 95% CI 11.4-38.3), obstetric embolism (adjusted OR 9.1; 95% CI 4.1-19.9), and other complications. Adverse neonatal outcomes associated with eclampsia included neonatal death (adjusted OR 2.9; 95% CI 1.6-5.5), respiratory distress syndrome (adjusted OR 5.1; 95% CI 4.1-6.3), and small-for-gestational age birth (adjusted OR 2.6; 95% CI 2.3-3.0).


CONCLUSIONS
Despite declining incidence and improved care of women with eclampsia, the condition remains strongly associated with serious adverse consequences.
From the Health Surveillance and Epidemiology Division, Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, Ottawa, Ontario, Canada; the Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Hospital of British Columbia, Vancouver, British Columbia, Canada; the School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; the Department of Obstetrics and Gynaecology, University of Ottawa and Ottawa Health Research Institute, Ottawa, Ontario, Canada; the Department of Community and Family Health, University of South Florida, Tampa, Florida; the Departments of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; the Departments of Pediatrics & Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada; and the Canadian Institutes of Health Research, Ottawa, Ontario, Canada.
Shiliang
S
Liu
K S
KS
Joseph
Robert M
RM
Liston
Sharon
S
Bartholomew
Mark
M
Walker
Juan Andrés
JA
León
Russell S
RS
Kirby
Reg
R
Sauve
Michael S
MS
Kramer
D000328:Adult; D002170:Canada / Q000453:epidemiology; D004461:Eclampsia / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007226:Infant Mortality; D007231:Infant, Newborn; D008428:Maternal Mortality; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult