Triggers for Preeclampsia Onset: a Case-Crossover Study.
Risk factors for preeclampsia are well established, whereas, the triggers associated with timing of preeclampsia onset are not. The aim of this study was to establish whether recent infection or other triggers were associated with timing of preeclampsia onset.



We used a case-crossover design with preeclampsia cases serving as their own controls. Women with singleton pregnancies of ≥20 weeks gestation presenting at three hospitals were eligible for inclusion. Exposures to potential triggers were identified via guided questionnaire. Infective episodes included symptoms lasting >24 h. Preeclampsia was defined as hypertension (BP ≥140 mmHg and/or ≥90 mmHg) and proteinuria (protein/creatinine ratio ≥30 mg/mmol). Conditional logistic regression was used to compare the odds of exposure to potential triggers in the case windows (1-7 days preceding diagnosis of preeclampsia) and control windows (8-14 days prior to diagnosis); unadjusted odds ratios (ORs) are reported.



Among 286 recruited women, 25 (8.7%) reported a new infection in the 7 days prior to preeclampsia onset and 21 (7.3%) in the 8-14 days prior. There was no significant association between onset of infection in the 7 days prior and preeclampsia diagnosis (OR 1.24, 95% CI 0.65, 2.34). Consumption of caffeine (OR 0.51, 95% CI 0.33, 0.77), spicy food (OR 0.49, 95% CI 0.30, 0.81), and alcohol (OR 0.26, 95% CI 0.10, 0.71) were strongly inversely associated with preeclampsia onset.



Recent infection does not appear to trigger preeclampsia. Decreased consumption of caffeine, spicy food, and alcohol may be prodromal markers. Such behaviours may be early markers of imminent preeclampsia.
Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.|Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.
Jane B
JB
Ford
Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.|New South Wales Ministry of Health, North Sydney, NSW, Australia.
Kathrin
K
Schemann
Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.|Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.
Jillian A
JA
Patterson
Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.|Obstetrics and Gynaecology Department, Royal North Shore Hospital, St Leonards, NSW, Australia.
Jonathan
J
Morris
Neuroscience Research Australia, Randwick, NSW, Australia.
Robert D
RD
Herbert
Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.|Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.
Christine L
CL
Roberts
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology; D002110:Caffeine / Q000009:adverse effects; D000697:Central Nervous System Stimulants / Q000009:adverse effects; D018592:Cross-Over Studies; D005260:Female; D005502:Food / Q000009:adverse effects; D006801:Humans; D008423:Maternal Age; D008875:Middle Aged; D009517:New South Wales; D011225:Pre-Eclampsia / Q000453:epidemiology / Q000209:etiology*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology; D012307:Risk Factors; D055815:Young Adult
D000697:Central Nervous System Stimulants; D002110:Caffeine
Infection; Pre-Eclampsia; Pregnancy