Preeclampsia: prediction and prevention

She is 11 weeks, 38 years old, first pregnancy, body mass index 36, and her mother had eclampsia. Nothing is wrong with her today. Everything you can do to change her outcome has to happen in the next five weeks — after that the placenta is built and aspirin largely stops working.^[4][16]

Overview and definition

Prevention has a narrow target and a narrow window. The target is preterm preeclampsia — the placental phenotype that drives iatrogenic prematurity, growth restriction and most of the maternal deaths. The window is the first 16 weeks, while spiral artery remodelling is still under way.^[3][4][16]

• Preterm preeclampsia — birth required before 37 weeks. This is what ASPRE reduced and what screening programmes are built around.^[3]
• Early-onset preeclampsia — before 34 weeks. Smaller in number, disproportionate in harm, most strongly placental.^[17][19]
• Term preeclampsia — the largest group by count, more maternal-cardiovascular in origin, and stubbornly resistant to aspirin.^[17][19]

References22ShowHide

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