Pre-eclampsia: Risk factors and causal models.

Pre-eclampsia is a disease of many risk factors and theoretical speculations. It is, for unknown reasons, more prevalent among primiparous women. Some observations show that a change of sexual partner before the next pregnancy increases the risk, but this association disappears when correction is made for time interval since the last birth. Risk factors may be pregnancy-specific, such as twinning or mole, whereas others are linked to the woman, such as obesity and diabetes. Genetic risk factors are being searched for, but as yet with relatively little success. A previous pregnancy complicated by pre-eclampsia is probably the strongest risk factor. For practical purposes, women at increased risk can be identified and should be followed closely. No effective primary preventative action is available. Prevention of the serious consequences of pre-eclampsia still relies on early detection of increases in blood pressure and proteinuria.