Page 186 - Pro-active Management of Women’s Health after Cardiometabolic Complicated Pregnancies

184 | Part 4 Discussion
The NICE guideline (2011)288 does not address postpartum cardiometabolic screening yet. However, more recent developed guidelines do address this need of postpartum cardiometabolic screening after preeclampsia, but in various ways due to low-level evidence on screening strategies (cohorts or case-control studies or expert opinions). The variations are explicated in table 4.1. Explicit follow-up on hypertension and proteinuria are mostly not mentioned. Only one guideline (SGOC289) mentions a timeframe when to screen or act and one other guideline (ACOG287) takes severity of preeclampsia into account.
The Dutch guideline is most conservative regarding cardiometabolic screening, recommending only to start at the age of 50291. In case hypertension and proteinuria resolve within 2 years postpartum, this is a good recommendation, given the lack of evidence on the effect on future cardiometabolic events of routine postpartum extensive cardiometabolic screening.
More evidence is needed to uniform best practice of postpartum follow-up and screening after preeclampsia. Studies should focus on the chance of finding (1) modifiable risk factors, (2) treatable risk factors and (3) on the reduction of cardiovascular risk. Screening should not start before 2 years postpartum to reduce the risk of over-treatment when spontaneous recovery is still at hand.
Preeclampsia as risk factor of future cardiovascular disease
This thesis shows that preeclampsia is not just a marker, but an independent risk factor for future cardiovascular risk. Modelled odds-ratios for cardiovascular risk, based on differences in cardiometabolic health between formerly preeclamptic women and women with an uncomplicated pregnancy,