Preeclampsia affects an estimated 3 to 8% of pregnancies worldwide, and hypertensive disorders of pregnancy are responsible for roughly 16% of maternal deaths. Whether you're a seasoned attending or a third-year medical student who has only done one labor and delivery rotation, chances are you've already cared for a patient whose pregnancy was complicated by this condition.

Medicine tends to focus heavily on treatment, but disease prevention matters just as much, and that starts with understanding risk factors. This episode breaks down the risk factors for preeclampsia into two categories: high-risk and moderate-risk, and walks through what to actually do with that information once you have it.

Before We Get Into It: Enrollment for OB/GYN Residency Bootcamp Closes June 30

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Two Categories of Risk Factors

Risk factors for preeclampsia fall into two buckets:

High-risk factors: comorbid conditions that each individually confer an expected 8% or greater risk of developing preeclampsia during pregnancy.

Moderate-risk factors: each one is associated with preeclampsia, but it's the combination of two or more that substantially increases risk.

High-Risk Factors

Personal history of preeclampsia
Chronic hypertension
Pregestational diabetes (type 1 or type 2)
Autoimmune disease (for example, lupus or antiphospholipid antibody syndrome)
Renal disease
Multifetal gestation (twins, triplets, etc.)

Moderate-Risk Factors

Pregnancies conceived via IVF
Obesity (BMI of 30 or greater)
Nulliparity
Family history of preeclampsia in the patient's mother or sister
Low income or low socioeconomic status
Advanced maternal age (35 or greater by the estimated due date)
History of adverse pregnancy outcomes (for example, a small for gestational age fetus or low birth weight infant)
A greater than 10-year interval since the last delivery
Black race

An important note on race: Black individuals do not have a biological propensity for preeclampsia. This is a risk factor driven by racism and the social and structural inequities that come with it, not by biology.

So What Do We Do With This Information?

ACOG, the Society for Maternal-Fetal Medicine, and the US Preventive Services Task Force all support initiating low-dose aspirin between 12 and 28 weeks gestation, ideally between 12 and 16 weeks, to prevent or delay the onset of preeclampsia in patients with one high-risk factor or two or more moderate-risk factors.

Final Recap

Preeclampsia is common enough that nearly every OB/GYN trainee will care for a patient affected by it. Knowing the high-risk and moderate-risk factors, and knowing when low-dose aspirin is indicated, is one of the simplest and highest-yield ways to catch this early and improve outcomes.