title: Preeclampsia: Reflections on How to Counsel About Preventing Recurrence.
abstract: Preeclampsia is one of the most challenging diseases of pregnancy, with unclear etiology, no specific marker for prediction, and no precise treatment besides delivery of the placenta. Many risk factors have been identified, and diagnostic and management tools have improved in recent years. However, this disease remains one of the leading causes of maternal morbidity and mortality worldwide, especially in under-resourced settings. A history of previous preeclampsia is a known risk factor for a new event in a future pregnancy, with recurrence rates varying from less than 10% to 65%, depending on the population or methodology considered. A recent review that performed an individual participant data meta-analysis on the recurrence of hypertensive disorders of pregnancy in over 99 000 women showed an overall recurrence rate of 20.7%; when specifically considering preeclampsia, it was 13.8%, with milder disease upon recurrence. Prevention of recurrent preeclampsia has been attempted by changes in lifestyle, dietary supplementation, antihypertensive drugs, antithrombotic agents, and others, with much uncertainty about benefit. It is always challenging to treat and counsel a woman with a previous history of preeclampsia; this review will be based on hypothetical clinical cases, using common scenarios in obstetrical practice to consider the available evidence on how to counsel each woman during pre-conception and prenatal consultations.
authors.affiliation: Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medicine, Campinas, São Paulo, Brazil.
authors.forename: Maria Laura
authors.initials: ML
authors.lastname: Costa
mesh_terms: D000328:Adult; D037001:Directive Counseling; D005260:Female; D006801:Humans; D011225:Pre-Eclampsia / Q000517:prevention & control*; D011247:Pregnancy; D012008:Recurrence; D012307:Risk Factors
keywords: maternal morbidity; preeclampsia; pregnancy; recurrence