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

Objective (1) To estimate the time required for hypertension and proteinuria to resolve after preeclampsia. (2) How this time to resolution correlate with the levels of blood pressure and proteinuria during preeclampsia and the prolongation of pregnancy after the development of preeclampsia. Methods This is a historical prospective cohort study of 205 preeclamptic women, who were admitted between 1990 and 1992 at the Erasmus University Medical Center in Rotterdam, the Netherlands. Data were collected at 1.5, three, six, 12, 18 and 24 months after delivery. Hypertension was defined as a blood pressure ≥ 140/90 mmHg or use of antihypertensive drugs. Proteinuria was defined as ≥ 0.3 gram/day. Resolution of hypertension and proteinuria were analyzed with Turnbull’s extension to the Kaplan-Meier procedure. Correlations were calculated with an accelerated failure time model. Results At three months postpartum 39% still had hypertension, falling to 18% at two years postpartum. Resolution time increased with higher systolic (p<0.001) and diastolic blood pressure during preeclampsia (p=0.044), as well as a longer time interval between diagnosis and delivery (p=0.001). At three months postpartum 14% still had proteinuria, falling to 2% at two years postpartum. Resolution time increased with higher levels of proteinuria during preeclampsia (p<0.001). Gestational age at onset of preeclampsia was not correlated with resolution time of hypertension and proteinuria. Conclusion Following a preeclampsia, it can take up to two years for hypertension and proteinuria to resolve. Therefore, we suggest that further invasive diagnostic tests for underlying renal disease may be postponed until two years postpartum. 2.1 Resolution of hypertension and proteinuria| 25