Primipaternities in Families: Is the Incidence of Pregnancy‐induced Hypertensive Disorders in Multigravidas an Anthropological Marker of Reproduction?

EDITORIAL COMMENT: : We accepted this paper for publication because it provided a careful review of the literature concerning the incidence of preeclampsia in relationship to the duration of sexual cohabitation before a first pregnancy with a new partner, and other imponderables concerning human reproduction and sexual behaviour in different populations. The authors' style of presentation is unusual and has been spared routine editorial alteration. The first author together with Desmond Cooper has arranged an International Workshop on the Immunology of Preeclampsia to be held in Moorea, French Polynesia from April 29‐May 2, 1998. At this meeting the information in this paper will be presented by Pierre‐Yves Robillard, and Gustaaf Dekker will present ‘Prevention of preeclampsia: Sperm exposure and information concerning preeclampsia and preliminary results of immunonutrition trial’. There is an interesting analogy between preeclampsia, one of the commonest complications of pregnancy, and massive hypertrophy of the breasts in pregnancy, which has an incidence of less than 1 in 100,000 pregnancies (A), namely the possibility of an immunological factor provided by a new partner although previous pregnancies with different partners had not been associated with breast abnormalities; in 2 of 3 cases reported (A) the pregnancy was conceived with a new partner and the massive hypertrophy began before the first missed period which is much earlier in gestation than the trophoblastic association with preeclampsia hypothesized in this paper. (A) Beischer NA, Heuston JH, Pepperell RJ. Massive hypertrophy of the breasts in pregnancy: report of 3 cases and review of the literature, ‘never think you have seen everything’. Obstet Gynecol Surv 1989; 44: 234–243. Summary: Pregnancy‐induced hypertensive disorders (and especially preeclampsia) remain nowadays the major problem of human reproduction as it occurs in at least 10% of all world population births. It is a major cause of maternal‐fetal mortality and morbidity in developed and developing countries. This disease was until recently classically considered as a disease of primigravidas with little recurrence in multigravidas. Nevertheless, recent evidences in the last half decade suggest that this disease is indeed a disease of first pregnancies, but at the level of a couple (primipaternity) rather than only the mother's side (primigravidity). Therefore, multigravidas share the risk with primigravidas in case of conception with a new partner. We expose the biological plausibility of this new approach (immunogenetic factors), and propose its epidemiological consequences with proposals of future research for health workers or demographers working at the level of populations. If pregnancy‐induced disorders are disease of new couples, then their patterns are probably very different according to the broad reproductive patterns existing among different cultures (contraception, matrifocality or patrifocality, age at marriage, changes of reproductive partners et cetera).