Page 27 - Pro-active Management of Women’s Health after Cardiometabolic Complicated Pregnancies

INTRODUCTION
Preeclampsia complicates about 5% of all pregnancies79. The associated hypertension and proteinuria usually resolve after delivery. But recent studies show that preeclampsia is associated with an increased risk for remote cardiovascular disease80 and end stage renal disease81. More knowledge on postpartum resolution of hypertension and proteinuria will help to properly identify chronic hypertension and proteinuria. This can help justify further invasive diagnostic tests for underlying disease.
The time required for resolution however is not clear. International guidelines state that hypertension should resolve within three months after a preeclamptic pregnancy82 83. Otherwise, chronic hypertension is present. Previous publications indeed show rapid postpartum fall of the blood pressure84- 87. However, they were not designed to estimate resolution after three months postpartum, having a follow-up period of seven days or excluding patients with persistent hypertension at three months postpartum. If data of resolution of hypertension beyond three months postpartum was available, women with chronic hypertension could be better identified. For proteinuria, no statement exists when postpartum persistence should be considered chronic. Previous publications suggest a high risk of renal injury if proteinuria is persistent after six or 12 weeks postpartum. However, publications are case reports88 or consist of retrospectively collected data on renal biopsies89 90. If prospectively collected data of postpartum resolution of proteinuria was available, women with persistent proteinuria could also be better identified. In our own experience, hypertension and proteinuria could resolve beyond three months after a preeclamptic pregnancy.
In this historical prospective cohort study, we address the following
2.1 Resolution of hypertension and proteinuria| 25