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Objective To study risk factors for pre-eclampsia in a large cohort of Latin American and Caribbean women.

Design Retrospective cross-sectional study from the Perinatal Information System, the database of the Latin American Center for Perinatology and Human Development, Montevideo, Uruguay.

Setting Latin America and the Caribbean, 1985–1997.

Population 878,680 pregnancies at 700 hospitals; of these 42,530 were complicated by pre-eclampsia and 1872 by eclampsia.

Main outcome measures Crude and adjusted relative risks (RR) of risk factors for pre-eclampsia. Adjusted relative risks were obtained after adjustment for potential confounding factors through multiple logistic regression models based on the method of generalised estimating equations.

Results The following risk factors were significantly associated with increased risk of pre-eclampsia: nulliparity (RR 2.38; 95% CI 2.28–2.49); multiple pregnancy (RR 2.10; 95% CI 1.90–2.32); history of chronic hypertension (RR 1.99; 95% CI 1.78–2.22); gestational diabetes mellitus (RR 1.93; 95% CI 1.66–2.25); maternal age ≥ 35 years (RR 1.67; 95% CI 1.58–1.77); fetal malformation (RR 1.26; 95% CI 1.16–1.37); and mother not living with infant's father (RR 1.21; 95% CI 1.15–1.26). Pre-eclampsia risk increased according to pre-pregnancy body mass index (BMI). In comparison with women with a normal pre-pregnancy BMI (19.8 to 26.0), the RR estimates were 1.57 (95% CI 1.49–1.64) and 2.81 95% CI 2.69–2.94), respectively, for overweight women (pre-pregnancy BMI = 26.1 to 29.0) and obese women (pre-pregnancy BMI > 29.0). Cigarette smoking during pregnancy and a pre-pregnancy BMI < 19.8 were significant protective factors against the development of pre-eclampsia. The pattern of risk factors among nulliparous and multiparous women was quite similar.

Conclusions Risk factors for pre-eclampsia observed among Latin American and Caribbean women are similar to those found among North American and European women.