Family history of pre-eclampsia as a predictor for pre-eclampsia in primigravidas

Objective: To assess the clinical utility of knowledge of a family history of pre-eclampsia as a predictor for the development of pre-eclampsia in primigravid women. Methods: 368 primigravid women were prospectively recruited from the outpatients department of an obstetric teaching hospital. Details of any family history of pre-eclampsia were obtained from the women and their subsequent obstetric outcomes were observed. Results: Of 368 primigravid women, 34 (9.2%) developed pre-eclampsia. Eighteen (4.9%) women of the total group stated that they had a mother (12), sister (five) or both (one) who had had pre-eclampsia. Of these 18 women, five (27.8%) developed pre-eclampsia. Of the women who had no family history, 29 (8.3%) developed pre-eclampsia (relative risk, RR = 3.4; 95% CI, 1.5–7.6; P = 0.018). Four (22.2%) of the women with a positive family history developed severe pre-eclampsia compared to 18 (5.1%) with a negative family history (RR = 4.3; 95% CI, 1.6-11.5; P = 0.017). Conclusions: In a primigravida, a family history of pre-eclampsia is associated with a fourfold increased risk of severe pre-eclampsia. This clinical history identifies a group who warrant close clinical surveillance during pregnancy and who may be suitable for trials of prophylactic interventions.