FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 346:33-38 January 3, 2002 Number 1 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background The risk of preeclampsia is generally lower in second pregnancies than in first pregnancies, but not if the mother has a new partner for the second pregnancy. One explanation is that the risk is reduced with repeated maternal exposure and adaptation to specific antigens from the same partner. However, the difference in risk might instead be explained by the interval between births. A longer interbirth interval may be associated with both a change of partner and a higher risk of preeclampsia.

Methods We used data from the Medical Birth Registry of Norway, a population-based registry that includes births that occurred between 1967 and 1998. We studied 551,478 women who had two or more singleton deliveries and 209,423 women who had three or more singleton deliveries.

Results Preeclampsia occurred during 3.9 percent of first pregnancies, 1.7 percent of second pregnancies, and 1.8 percent of third pregnancies when the woman had the same partner. The risk in a second or third pregnancy was directly related to the time that had elapsed since the preceding delivery, and when the interbirth interval was 10 years or more, the risk approximated that among nulliparous women. After adjustment for the presence or absence of a change of partner, maternal age, and year of delivery, the odds ratio for preeclampsia for each one-year increase in the interbirth interval was 1.12 (95 percent confidence interval, 1.11 to 1.13). In unadjusted analyses, a pregnancy involving a new partner was associated with higher risk of preeclampsia, but after adjustment for the interbirth interval, the risk of preeclampsia was reduced (odds ratio for preeclampsia with a change of partner, 0.73; 95 percent confidence interval, 0.66 to 0.81).

Conclusions The protective effect of previous pregnancy against preeclampsia is transient. After adjustment for the interval between births, a change of partner is not associated with an increased risk of preeclampsia.

Source Information

From the Section for Medical Statistics, Department of Public Health and Primary Health Care, and the Medical Birth Registry of Norway, Locus for Registry-Based Epidemiology, University of Bergen, Bergen, Norway (R.S., R.T.L.); and the Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, N.C. (A.J.W.).

Address reprint requests to Professor Skjærven at the Section for Medical Statistics, University of Bergen, Armauer Hansens Bldg., 5021 Bergen, Norway, or at rolv.skjaerven{at}smis.uib.no.

Full Text of this Article

Related Letters:

The Interval between Pregnancies and Preeclampsia
Saftlas A. F., Levine R. J., Skjærven R., Wilcox A. J., Lie R. T.
Extract | Full Text | PDF  
N Engl J Med 2002; 346:1831-1832, Jun 6, 2002. Correspondence

This article has been cited by other articles:

• Wang, A., Rana, S., Karumanchi, S. A. (2009). Preeclampsia: The Role of Angiogenic Factors in Its Pathogenesis. Physiology 24: 147-158 [Abstract] [Full Text]  
• Smith, S. D., Dunk, C. E., Aplin, J. D., Harris, L. K., Jones, R. L. (2009). Evidence for Immune Cell Involvement in Decidual Spiral Arteriole Remodeling in Early Human Pregnancy. Am. J. Pathol. 174: 1959-1971 [Abstract] [Full Text]  
• Trogstad, L., Magnus, P., Skjaerven, R., Stoltenberg, C. (2008). Previous abortions and risk of pre-eclampsia. Int J Epidemiol 37: 1333-1340 [Abstract] [Full Text]  
• Vikse, B. E., Irgens, L. M., Leivestad, T., Skjaerven, R., Iversen, B. M. (2008). Preeclampsia and the Risk of End-Stage Renal Disease. NEJM 359: 800-809 [Abstract] [Full Text]  
• Mikolajczyk, R. T., Zhang, J., Ford, J., Grewal, J. (2008). Effects of Interpregnancy Interval on Blood Pressure in Consecutive Pregnancies. Am J Epidemiol 168: 422-426 [Abstract] [Full Text]  
• Rasmussen, S., Irgens, L. M. (2008). History of Fetal Growth Restriction Is More Strongly Associated With Severe Rather Than Milder Pregnancy-Induced Hypertension. Hypertension 51: 1231-1238 [Abstract] [Full Text]  
• Magnussen, E. B., Vatten, L. J., Lund-Nilsen, T. I., Salvesen, K. A., Smith, G. D., Romundstad, P. R. (2007). Prepregnancy cardiovascular risk factors as predictors of pre-eclampsia: population based cohort study. BMJ 335: 978-978 [Abstract] [Full Text]  
• Brosens, I. A., De Sutter, P., Hamerlynck, T., Imeraj, L., Yao, Z., Cloke, B., Brosens, J. J., Dhont, M. (2007). Endometriosis is associated with a decreased risk of pre-eclampsia. Hum Reprod 22: 1725-1729 [Abstract] [Full Text]  
• Royce, R. A. (2006). Birth spacing--the long and short of it.. JAMA 295: 1837-1838 [Full Text]  
• Skjaerven, R., Vatten, L. J, Wilcox, A. J, Ronning, T., Irgens, L. M, Lie, R. T. (2005). Recurrence of pre-eclampsia across generations: exploring fetal and maternal genetic components in a population based cohort. BMJ 331: 877- [Abstract] [Full Text]  
• Karmaus, W., Johnson, C. C. (2005). Invited Commentary: Sibship Effects and a Call for a Comparative Disease Approach. Am J Epidemiol 162: 133-138 [Full Text]  
• Duckitt, K., Harrington, D. (2005). Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. BMJ 330: 565- [Abstract] [Full Text]  
• Wolf, M., Shah, A., Jimenez-Kimble, R., Sauk, J., Ecker, J. L., Thadhani, R. (2004). Differential Risk of Hypertensive Disorders of Pregnancy among Hispanic Women. J. Am. Soc. Nephrol. 15: 1330-1338 [Abstract] [Full Text]  
• Vatten, L. J, Skjaerven, R. (2003). Effects on pregnancy outcome of changing partner between first two births: prospective population study. BMJ 327: 1138- [Abstract] [Full Text]  
• Saftlas, A. F., Levine, R. J., Klebanoff, M. A. (2003). THREE AUTHORS REPLY. Am J Epidemiol 158: 825-825 [Full Text]  
• Saftlas, A. F., Levine, R. J., Klebanoff, M. A., Martz, K. L., Ewell, M. G., Morris, C. D., Sibai, B. M. (2003). Abortion, Changed Paternity, and Risk of Preeclampsia in Nulliparous Women. Am J Epidemiol 157: 1108-1114 [Abstract] [Full Text]  
• Sweeney, E, Fryer, A, Mountford, R, Green, A, McIntosh, I (2003). Nail patella syndrome: a review of the phenotype aided by developmental biology. J. Med. Genet. 40: 153-162 [Abstract] [Full Text]  
• Basso, O., Weinberg, C. R., Baird, D. D., Wilcox, A. J., Olsen, J. (2003). Subfecundity as a Correlate of Preeclampsia: A Study within the Danish National Birth Cohort. Am J Epidemiol 157: 195-202 [Abstract] [Full Text]  
• Darling-Hammond, L., Youngs, P. (2002). Defining "Highly Qualified Teachers": What Does "Scientifically-Based Research" Actually Tell Us?. EDUCATIONAL RESEARCHER 31: 13-25  
• Saftlas, A. F., Levine, R. J., Skjaerven, R., Wilcox, A. J., Lie, R. T. (2002). The Interval between Pregnancies and Preeclampsia. NEJM 346: 1831-1832 [Full Text]