Page 37 - Pro-active Management of Women’s Health after Cardiometabolic Complicated Pregnancies

after delivery84. However, women with persistent hypertension at 50 days postpartum were excluded for analysis, thereby precluding any estimate of later resolution. Suzuki et al87 describe a postpartum observational study of 52 women with gestational hypertension. Of the 52 women, 9 (17%) still had hypertension two years postpartum. However, the rate of resolution between delivery and two years postpartum was not analyzed.
We found an incidence of proteinuria of 14% at three months postpartum. This is higher than in previous studies. In 1992 Chua and Redman describe a longitudinal study on the resolution of proteinuria after preeclampsia93. They showed persistent proteinuria in 2% at three months postpartum. However, proteinuria was defined as ≥ 0.5 gram protein a day. That might explain the difference with our findings.
Other studies have looked at renal lesions after preeclampsia89 90. Two types of renal lesions, characteristic for preeclampsia, can be discriminated: Those that disappear within days after delivery (glomerular deposits of various hemostatic factors) and those that resolve gradually until as long as 18 months after delivery (endothelial swelling and subendothelial enlargement). The latter supports our conclusion that proteinuria at three months postpartum does not imply chronic disease, but might still be a transient effect of endothelial damage during preeclampsia. Moreover, this finding suggests that a renal biopsy for prolonged proteinuria within two years postpartum may be postponed, since the majority of lesions will disappear.
Sometimes, resolution of proteinuria might be explained by a fall in glomerular filtration rate, or a decrease in blood pressure. Unfortunately, serum- creatinine levels were not routinely measured during follow-up, since all but five women had normal serum-creatinine levels within three months postpartum. So, we think it to be very unlikely that a fall in glomerular filtration rate would
2.1 Resolution of hypertension and proteinuria| 35