Preeclampsia and long-term kidney outcomes

Preeclampsia, a major cause of maternal and perinatal mortality, is characterised by new-onset hypertension and end-organ damage, including proteinuria and acute kidney injury, at or beyond 20 weeks’ gestation. The broader entity of hypertension in pregnancy is a risk factor for hypertension, cardiac disease and cerebrovascular events later in life, but less is known about the long-term prognosis of preeclampsia with regard to cardiac and kidney outcomes.

Using medical records from a large tertiary health system in a single state in the US, the present study evaluated the long-term risk of developing hypertension, reduced eGFR or albuminuria after an episode of preeclampsia. Data from 27,800 adults (mean age 28 years), with an obstetric delivery between 1996 and 2019, were used to compare maternal outcomes following deliveries that were complicated by preeclampsia to those that were not. 

In this cohort, 2977 (10.7%) individuals had a least one pregnancy complicated by preeclampsia. Overall follow-up was 21 years. In a propensity-score matched cohort, those who had experienced preeclampsia had a higher risk of future hypertension (HR, 1.77 [95% CI, 1.45–2.16]), eGFR <60 mL/min/m² (HR, 3.23 [1.64–6.36]) and albuminuria >30 mg/mmol (HR, 3.60 [2.38–5.44]) compared to controls.

Women who had a previous episode of preeclampsia had a significantly higher risk of a future pregnancy complicated by preeclampsia (HR, 24.56 [12.47–48.26]). Overall, post-partum screening for hypertension and kidney disease was low. In the first 6 months after delivery, 31% of those with preeclampsia had serum creatinine tests compared to 14% of those without, while 26% in both groups had follow-up protein tests.

The authors conclude that women who develop preeclampsia during pregnancy are at high risk for chronic hypertension and kidney disease, and that there is a need for appropriate post-partum monitoring and control of modifiable risk factors.

The full article can be read here.