What condition is a first-time pregnant woman more susceptible to?

Pre-eclampsia is the Condition First-Time Pregnant Women Are Most Susceptible To

Pre-eclampsia is primarily a disease of first pregnancies, making first-time pregnant women significantly more susceptible to this condition compared to the other options listed. 1

Epidemiological Evidence for First Pregnancy Risk

The evidence unequivocally demonstrates that pre-eclampsia has a strong association with primiparity:

• Pre-eclampsia occurs in approximately 4.1% of first pregnancies compared to only 1.7% in subsequent pregnancies overall 2
• For multiparous women without a history of pre-eclampsia, the risk drops to around 1%, demonstrating the dramatic protective effect of having had a previous uncomplicated pregnancy 2
• The NHLBI Working Group explicitly states that "preeclampsia is a disease primarily of first pregnancies and extremes of maternal age" 1

Why First Pregnancies Are at Higher Risk

The increased susceptibility in first-time mothers relates to immunologic and vascular factors:

• New paternal antigen exposure appears to play a role, as multigravidas pregnant by a new partner have an intermediate risk between first pregnancies and subsequent pregnancies with the same partner 1
• Longer periods of intercourse with the father before conception reduce risk, while barrier contraceptives that prevent semen exposure increase risk, supporting an immunologic basis 1
• The pathophysiology involves abnormal placental implantation and failure of spiral artery remodeling, processes that appear more likely to fail in first pregnancies 1

Comparison with Other Options

While the other conditions listed can occur in pregnancy, none show the same primiparity-specific pattern:

• Physiological anemia occurs commonly in all pregnancies regardless of parity due to plasma volume expansion
• Gestational hypertension can occur in first or subsequent pregnancies without the same primiparity predominance as pre-eclampsia 1
• Gestational diabetes is actually more common in multiparous women and those with advancing maternal age, not specifically first-time mothers

Clinical Implications

The strong first-pregnancy association has important practical consequences:

• First-time mothers require heightened surveillance for signs of pre-eclampsia, particularly blood pressure monitoring and proteinuria screening 1
• Women who develop pre-eclampsia in their first pregnancy face a 14.7% recurrence risk in their second pregnancy, and 31.9% if affected in two consecutive pregnancies 2
• Early-onset pre-eclampsia (before 34 weeks) shows even stronger recurrence patterns, with rates of 6.8% after one affected pregnancy and 12.5% after two 2

The answer is D. Pre-eclampsia - this is the condition for which first-time pregnancy represents the single strongest epidemiologic risk factor among the options provided.