Page 185 - Pro-active Management of Women’s Health after Cardiometabolic Complicated Pregnancies

This thesis should make us rethink on how cardiometabolic complications of pregnancy should be interpreted. It shows that cardiovascular recovery after preeclampsia could take as long as 2 years after delivery. It also presents preeclampsia not only as a marker, but as an independent risk factor of future cardiovascular disease. Finally, it describes a complicated pregnancy as a unique opportunity by using pregnancy as a stress-test to identify women at increased risk of future cardiometabolic disease. Women with a complicated pregnancy often struggle with their newly acquired motherhood, physical and psychological complaints and feelings of guilt, anxiety and worry for the health of their newborn and their own. This thesis proves lifestyle intervention as a feasible and probably effective way to offer these women a chance of a healthier future.
Postpartum recovery after preeclampsia
Recovery of hypertension and proteinuria can last until 2 years after preeclampsia. Severity and duration of preeclampsia affect postpartum recovery. The more severe the preeclampsia is and the longer it is prolonged, the longer it takes to recover which can take up to 2 years after delivery. At the regular check-up at 6 weeks postpartum, the gynecologist and midwife have a unique opportunity to identify women who are not fully recovered and need close cardiometabolic follow-up.
If hypertension or proteinuria persist at 6 to 12 weeks postpartum, the chance of resolving is still 50-85%. The chance of persistent hypertension after 2 years is 18%. And although persistent proteinuria at 2 years postpartum is rare (2%), identification of persistent disease could initiate proper treatment and limit progression of cardiometabolic disease over time. Moreover, persistent hypertension or proteinuria should initiate broad cardiometabolic screening for other traits, like dyslipidemia or impaired glucose intolerance.
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