Secular Trends in Preeclampsia Incidence and Outcomes in a Large Canada Database: A Longitudinal Study Over 24 Years
Abstract
Background The incidence of preeclampsia is increasing, but effects on women and infants are unclear. We measured the incidence of preeclampsia over time in a large Canadian population, and assessed trends in maternal and infant morbidity and mortality.Methods We carried out a population-based study of 1,901,376 linked hospital discharge abstracts for all deliveries in the province of Quebec, Canada from 1989 through 2012. We computed the annual incidence of preeclampsia, and used log binomial models to determine associations with severe morbidity and mortality for preeclamptic vs nonpreeclamptic pregnancies. Main outcomes included maternal, fetal, and infant mortality, admission to intensive care, intubation, preterm delivery, growth restriction, cesarean delivery, transfusion, and severe medical complications.Results The incidence of preeclampsia increased from 26.4 per 1000 deliveries in 1989 to 50.6 in 2012. Maternal, fetal, and infant mortality decreased with time for preeclamptic but not for nonpreeclamptic pregnancies. By 2007-2012, risk for women with preeclampsia had declined for most maternal morbidities, except acute renal failure, which increased relative to no preeclampsia (risk ratio, 21.5; 95% confidence interval, 16.9-27.3). Risk of infant morbidity also decreased, but this coincided with an increase in the excess number of intubations and admissions for intensive care for preeclampsia relative to no preeclampsia.Conclusions The incidence of preeclampsia increased during the study, but with little effect on the risk of maternal and infant morbidity and mortality. For most outcomes, the risk decreased relative to no preeclampsia, with more aggressive medical management over time.
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Recent evidence indicates an increase in the incidence rate of hypertensive disorders of pregnancy over the past few decades.
“Recent evidence has indicated an increase in the incidence rate of HDP over the past few decades, [7, 8]”
From Epidemiological trends of maternal hypertensive disorders of pregnancy at the global, regional, and national levels: a population‐based study (2021) · cites this paper as [7]
The incidence of preeclampsia varies among different countries and regions, making the disease burden of hypertensive disorders of pregnancy difficult to estimate and prevention difficult among pregnant women globally.
“The incidence of preeclampsia also varies among different countries and regions, and thus the disease burden of HDP is difficult to estimate and HDP prevention is difficult among pregnant women globally [7–11].”
From Epidemiological trends of maternal hypertensive disorders of pregnancy at the global, regional, and national levels: a population‐based study (2021) · cites this paper as [7]
The decreasing trends in HDP deaths and ASDR may be due to advances in medical interventions and gradually increasing attention to HDPs by clinicians worldwide.
“which may be due to the advances medical interventions and gradually increasing attention to HDPs by clinicians worldwide [7].”
From Epidemiological trends of maternal hypertensive disorders of pregnancy at the global, regional, and national levels: a population‐based study (2021) · cites this paper as [7]
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- Authors
- Auger, N., Luo, Z.-C., Nuyt, A. M., Kaufman, J. S., Naimi, A. I., Platt, R. W., & Fraser, W. D.
- Affiliations
- Institut National de Santé Publique du Québec (CA)
- Université de Montréal (CA)
- McGill University (CA)
- Université de Sherbrooke (CA)
- Corresponding author
- Auger, Nathalie
- ORCID
- Venue
- Canadian Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2016-08
- Volume
- 32
- Issue
- 8
- Pages
- 987.e15-987.e23
- ISSN
- 0828-282X (ISSN-L)
- OpenAlex
- W2221015911
- Cited by
- 83
- References
- 32
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 9 · 2023: 11 · 2022: 10 · 2021: 16 · 2020: 10 · 2019: 6 · 2018: 8 · 2017: 3 · 2016: 2
- FWCI
- 4.93
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Canadian Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research (MOP-130452)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Health Sciences › Medicine › Psychiatry and Mental health › Neurological Complications and Syndromes
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
- Keywords
- preeclampsia, incidence trends, maternal morbidity, maternal mortality, fetal death, infant mortality, acute kidney injury, intensive care unit admission, intubation, preterm birth, growth restriction, cesarean section, Quebec
- MeSH terms
- Adult, Blood Transfusion, Female, Humans, Infant, Infant, Newborn, Intensive Care Units, Intubation, Intratracheal, Longitudinal Studies, Maternal Mortality, Patient Admission, Pre-Eclampsia, Pregnancy, Quebec, Incidence, Databases, Factual, Perinatal Mortality, Acute Kidney Injury
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