Prevalence of Preeclampsia in Brazil: An Integrative Review

We performed an integrative review of the literature, and included observational studies published until August 2021 on the SciELO and PubMed databases that evaluated preeclampsia among pregnant women in Brazil. Other variables of interests were maternal death, neonatal death, hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome, and eclampsia. Three independent reviewers evaluated all retrieved studies and selected those that met inclusion criteria. A metanalysis of the prevalence of preeclampsia and eclampsia was also performed, to estimate a pooled frequency of those conditions among the studies included.

Results

We retrieved 304 studies after the initial search; of those, 10 were included in the final analysis, with a total of 52,986 women considered. The pooled prevalence of preeclampsia was of 6.7%, with a total of 2,988 cases reported. The frequency of eclampsia ranged from 1.7% to 6.2%, while the occurrence of HELLP syndrome was underreported. Prematurity associated to hypertensive disorders ranged from 0.5% to 1.72%.

Conclusion

The frequency of preeclampsia was similar to that reported in other international studies, and it is increasing in Brazil, probably due to the adoption of new diagnostic criteria. The development of a national surveillance network would be essential to understand the problem of hypertensive disorders of pregnancy in Brazil.

Keywords
preeclampsia; epidemiology; Brazil

Author (year)	Setting	N	Preeclampsia	Eclampsia	HELLP syndrome	Perinatal death	Prematurity
Gaio et al. (2001)¹¹11 Gaio DS, Schmidt MI, Duncan BB, Nucci LB, Matos MC, Branchtein L. Hypertensive disorders in pregnancy: frequency and associated factors in a cohort of Brazilian women. Hypertens Pregnancy 2001; 20 (03) 269-281 DOI: 10.1081/PRG-100107829. https://doi.org/10.1081/PRG-100107829...	Manaus, Fortaleza, Salvador, Rio de Janeiro, São Paulo, and Porto Alegre	4,892	113	7	Not reported	Not reported	Not reported
Gonçalves et al. (2005)¹²12 Gonçalves R, Fernandes RA, Sobral DH. [Prevalence of specific hypertensive disease of pregnancy in a public hospital of the city of São Paulo]. Rev Bras Enferm 2005; 58 (01) 61-64 DOI: 10.1590/s0034-71672005000100011. https://doi.org/10.1590/s0034-7167200500...	São Paulo	604	22	1	Not reported	7	3
Dantas et al. (2013)¹³13 Dantas EM, Pereira FV, Queiroz JW, Dantas DL, Monteiro GR, Duggal P. et al. Preeclampsia is associated with increased maternal body weight in a northeastern Brazilian population. BMC Pregnancy Childbirth 2013; 13: 159 DOI: 10.1186/1471-2393-13-159. https://doi.org/10.1186/1471-2393-13-159...	Natal	212	30	Not reported	1	Not reported	Not reported
Wendland et al. (2008)¹⁴14 Wendland EM, Duncan BB, Belizán JM, Vigo A, Schmidt MI. Gestational diabetes and pre-eclampsia: common antecedents?. Arq Bras Endocrinol Metabol 2008; 52 (06) 975-984 DOI: 10.1590/s0004-27302008000600008. https://doi.org/10.1590/s0004-2730200800...	Porto Alegre, São Paulo, Rio de Janeiro, Salvador, Fortaleza, and Manaus	4,766	148	Not reported	Not reported	Not reported	Not reported
Reichelt et al. (2017)¹⁵15 Reichelt AJ, Weinert LS, Mastella LS, Gnielka V, Campos MA, Hirakata VN. et al. Clinical characteristics of women with gestational diabetes - comparison of two cohorts enrolled 20 years apart in southern Brazil. Sao Paulo Med J 2017; 135 (04) 376-382 DOI: 10.1590/1516-3180.2016.0332190317. https://doi.org/10.1590/1516-3180.2016.0...	Porto Alegre	591	65	Not reported	Not reported	Not reported	Not reported
Mayrink et al. (2019)¹⁰10 Mayrink J, Souza RT, Feitosa FE, Roch a Filho EA, Leite DF, Vettorazzi J. et al. Preterm SAMBA study group. Incidence and risk factors for Preeclampsia in a cohort of healthy nulliparous pregnant women: a nested case-control study. Sci Rep 2019; 9 (01) 9517 DOI: 10.1038/s41598-019-46011-3. https://doi.org/10.1038/s41598-019-46011...	Campinas, Botucatu, Porto Alegre, and Fortaleza	1,165	87	Not reported	Not reported	Not reported	20
Ramos Filho e Antunes (2020)¹⁹19 Ramos Filho FL, Antunes CMF. Hypertensive disorders: prevalence, perinatal outcomes and cesarean section rates in pregnant women hospitalized for delivery. Rev Bras Ginecol Obstet 2020; 42 (11) 690-696 DOI: 10.1055/s-0040-1714134. https://doi.org/10.1055/s-0040-1714134...	Belo Horizonte	36,724	2,171	36	115	Not reported	Not reported
Sanchez et al. (2021)¹⁶16 Sanchez MP, Guida JP, Simões M, Marangoni-Junior M, Cralcev C, Santos JC. et al. Can pre-eclampsia explain higher cesarean rates in the different groups of Robson's classification?. Int J Gynaecol Obstet 2021; 152 (03) 339-344 DOI: 10.1002/ijgo.13370. https://doi.org/10.1002/ijgo.13370...	Campinas	3,102	258	Not reported	Not reported	Not reported	Not reported
Trindade et al. (2021)¹⁷17 Trindade CR, Torloni MR, Mattar R, Sun SY. Good performance of bioimpedance in early pregnancy to predict preeclampsia. Pregnancy Hypertens 2021; 26: 24-30 DOI: 10.1016/j.preghy.2021.08.115. https://doi.org/10.1016/j.preghy.2021.08...	Vitória	196	12	Not reported	Not reported	Not reported	Not reported
De Lima et al. (2021)¹⁸18 de Lima MC, Santos IDS, Crivellenti LC, Sartorelli DS. A better quality of maternal dietary fat reduces the chance of large-for-gestational-age infants: A prospective cohort study. Nutrition 2021; ;91-92: 111367 DOI: 10.1016/j.nut.2021.111367. https://doi.org/10.1016/j.nut.2021.11136...	Ribeirão Preto	734	82	Not reported	Not reported	Not reported	Not reported
Total	***	52,986	2,988	***	***	***	***

Study/Question	1	2	3	4	5	6	7	8	9	10	11	12	13	14
Gaio et al. (2001)¹¹11 Gaio DS, Schmidt MI, Duncan BB, Nucci LB, Matos MC, Branchtein L. Hypertensive disorders in pregnancy: frequency and associated factors in a cohort of Brazilian women. Hypertens Pregnancy 2001; 20 (03) 269-281 DOI: 10.1081/PRG-100107829. https://doi.org/10.1081/PRG-100107829...	Yes	Yes	Yes	Yes	No	Yes	Yes	No	Yes	No	Yes	No	Yes	Yes
Gonçalves et al. (2005)¹²12 Gonçalves R, Fernandes RA, Sobral DH. [Prevalence of specific hypertensive disease of pregnancy in a public hospital of the city of São Paulo]. Rev Bras Enferm 2005; 58 (01) 61-64 DOI: 10.1590/s0034-71672005000100011. https://doi.org/10.1590/s0034-7167200500...	Yes	Yes	No	Yes	No	Yes	Yes	No	Yes	No	Yes	No	Yes	Yes
Dantas et al. (2013)¹³13 Dantas EM, Pereira FV, Queiroz JW, Dantas DL, Monteiro GR, Duggal P. et al. Preeclampsia is associated with increased maternal body weight in a northeastern Brazilian population. BMC Pregnancy Childbirth 2013; 13: 159 DOI: 10.1186/1471-2393-13-159. https://doi.org/10.1186/1471-2393-13-159...	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes	Yes	No	Yes	Yes
Wendland et al. (2008)¹⁴14 Wendland EM, Duncan BB, Belizán JM, Vigo A, Schmidt MI. Gestational diabetes and pre-eclampsia: common antecedents?. Arq Bras Endocrinol Metabol 2008; 52 (06) 975-984 DOI: 10.1590/s0004-27302008000600008. https://doi.org/10.1590/s0004-2730200800...	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	No	No	No	Yes	Yes
Reichelt et al. (2017)¹⁵15 Reichelt AJ, Weinert LS, Mastella LS, Gnielka V, Campos MA, Hirakata VN. et al. Clinical characteristics of women with gestational diabetes - comparison of two cohorts enrolled 20 years apart in southern Brazil. Sao Paulo Med J 2017; 135 (04) 376-382 DOI: 10.1590/1516-3180.2016.0332190317. https://doi.org/10.1590/1516-3180.2016.0...	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	No	Yes	No	Yes	Yes
Mayrink et al. (2019)¹⁰10 Mayrink J, Souza RT, Feitosa FE, Roch a Filho EA, Leite DF, Vettorazzi J. et al. Preterm SAMBA study group. Incidence and risk factors for Preeclampsia in a cohort of healthy nulliparous pregnant women: a nested case-control study. Sci Rep 2019; 9 (01) 9517 DOI: 10.1038/s41598-019-46011-3. https://doi.org/10.1038/s41598-019-46011...	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes	Yes	No	Yes	Yes
Ramos Filho e Antunes (2020)¹⁹19 Ramos Filho FL, Antunes CMF. Hypertensive disorders: prevalence, perinatal outcomes and cesarean section rates in pregnant women hospitalized for delivery. Rev Bras Ginecol Obstet 2020; 42 (11) 690-696 DOI: 10.1055/s-0040-1714134. https://doi.org/10.1055/s-0040-1714134...	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	No	Yes	No	Yes	Yes
Sanchez et al. (2021)¹⁶16 Sanchez MP, Guida JP, Simões M, Marangoni-Junior M, Cralcev C, Santos JC. et al. Can pre-eclampsia explain higher cesarean rates in the different groups of Robson's classification?. Int J Gynaecol Obstet 2021; 152 (03) 339-344 DOI: 10.1002/ijgo.13370. https://doi.org/10.1002/ijgo.13370...	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	No	Yes	No	Yes	Yes
Trindade et al. (2021)¹⁷17 Trindade CR, Torloni MR, Mattar R, Sun SY. Good performance of bioimpedance in early pregnancy to predict preeclampsia. Pregnancy Hypertens 2021; 26: 24-30 DOI: 10.1016/j.preghy.2021.08.115. https://doi.org/10.1016/j.preghy.2021.08...	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	No	Yes	No	Yes	Yes
De Lima et al. (2021)¹⁸18 de Lima MC, Santos IDS, Crivellenti LC, Sartorelli DS. A better quality of maternal dietary fat reduces the chance of large-for-gestational-age infants: A prospective cohort study. Nutrition 2021; ;91-92: 111367 DOI: 10.1016/j.nut.2021.111367. https://doi.org/10.1016/j.nut.2021.11136...	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	No	Yes	No	Yes	Yes

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[1] Address for correspondence José Paulo de Siqueira Guida, MD, PhD, rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-881, Brazil (e-mail: zepauloguida@gmail.com).