Page 38 - Pro-active Management of Women’s Health after Cardiometabolic Complicated Pregnancies

36 | Part 2 Cardiovascular Health
have contributed to resolution of proteinuria. At every postpartum visit, blood pressure levels were comparable between women with and without proteinuria. So it is unlikely that the level of blood pressure has interfered with the resolution of blood pressure.
This study of resolution of hypertension and proteinuria could well reflect endothelial recovery after preeclampsia, as previously suggested84. Endothelial dysfunction plays a central role in the pathogenesis of preeclampsia and might account for most of the pathological changes94 95. Our findings suggest that the level of endothelial cell injury during preeclampsia, reflected by highest blood pressure and level of proteinuria, is correlated with the time to postpartum recovery. Whether prolonged resolution is reassuring, remains unclear. It might very well reflect worse subclinical cardiovascular health. This should be aim for further research. If true, it can help to identify women at risk for future cardiovascular disease.
Moreover, our findings also suggest that the duration of exposure to endothelial cell injury, as reflected by diagnose-to-delivery interval, is correlated with the time to postpartum resolution of hypertension. We are the first to describe this association. It suggests that preeclampsia itself affects remote cardiovascular health. This implies that temporizing treatment may increase remote cardiovascular risk. Whether this is true should be part of further study.
The main limitation of this study is the number of women lost-to-follow up. With regard to the Turnbull’s analysis, they are considered right-censored. This means that after the last known visit, they were expected to behave like the women with complete follow-up. Since the women lost-to-follow-up had more severe clinical features of preeclampsia, our method probably resulted in a best- case scenario. However, within the AFT-model the clinical features of preeclampsia have been adjusted for. These clinical features could be related to