P reeclampsia (PE), a serious hypertensive pregnancy disorder complicating 2% to 5% of all pregnancies, is characterized by new-onset hypertension along with de novo proteinuria after 20 weeks of gestation 1 or new-onset proteinuria that develops after 20 weeks in women with preexisting hypertension. Women with a history of PE have an increased risk to develop chronic hypertension and related cardiovascular morbidity and mortality. 2 PE is accompanied by concentric left ventricular remodeling along with diastolic dysfunction and reduced cardiac contractility.3 Accumulating evidence exists that women who experienced PE differ from their counterparts with uneventful pregnancies by persisting abnormal left ventricular geometry and decreased diastolic function.4-6 It may be that former patients with underlying susceptibility for cardiovascular disease (CVD) react to borderline blood pressure values by excessive cardiac remodeling that does not revert to normal after delivery. In this line of reasoning, the slight differences in left ventricular geometry and cardiac diastolic function may be an indication for an increased risk for chronic hypertension as an intermediate condition before later CVD. Therefore, we tested the hypothesis that increased measures of cardiac geometry and decreased cardiac function persisting for ≥6 months postpartum in normotensive women with a history of PE precede the development of later chronic hypertension. Methods Study PopulationThe Maastricht University Medical Center (MUMC) Medical Ethics Committee approved our study protocol before patient enrolment (MEC 0-4-049). Since 1996, we perform postpartum screening ≥4 months postpartum in women who experienced a pregnancy complicated by a hypertensive disorder. The procedures followed were in accordance with institutional guidelines. Informed consent related to the use of clinically acquired data for scientific analysis is standard given at MUMC. Procedures adhere to the principles of the Declaration of Helsinki and Title 45, US Code of Federal Regulations, Part 46, Protection of Human Subjects, Revised November 13, 2001, effective December 13, 2001. For the present study, we included all white primiparous women who were screened postpartum until 2008. PE was diagnosed on the basis of the criteria of the International Society for the Study of Hypertension in Pregnancy.7 Early-onset PE was defined as PE diagnosed before the 34th week of pregnancy. Subjects were scheduled for screening ≥4 weeks after stopping Abstract-Preeclampsia is associated with a 4-fold higher risk for developing remote chronic hypertension. Preeclampsia is accompanied by left ventricular hypertrophy and decreased diastolic function, which may or may not resolve postpartum. We tested the hypothesis that increased measures of cardiac geometry and decreased cardiac function persisting for ≥6 months postpartum in normotensive women with a history of preeclampsia precede the development of later chronic hypertension. Formerly preeclamptic women (n=652) underwent echocardio...

Women with a history of preeclampsia or gestational hypertension have features of the metabolic syndrome which are presumably present already before pregnancy, predisposing them to hypertensive disorders of pregnancy and later cardiovascular risk. In this study, we found no evidence for early renal damage, endothelial dysfunction or sympathetic overactivity in the postpartum state.

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ObjectivesTo review systematically current literature on kidney function changes during pregnancy, in order to estimate the extent of adaptation over the course of both healthy physiological and complicated singleton pregnancies, and to determine healthy pregnancy reference values.MethodsPubMed (NCBI) and EMBASE (Ovid) electronic databases were searched, from inception to July 2017, for studies on kidney function during uncomplicated and complicated pregnancies. Included studies were required to report a non‐pregnant reference value of kidney function (either in a non‐pregnant control group or as a prepregnancy or postpartum measurement) and a pregnancy measurement at a predetermined and reported gestational age. Kidney function measures assessed were glomerular filtration rate (GFR) measured by inulin clearance, GFR measured by creatinine clearance and serum creatinine level. Pooled mean differences between pregnancy measurements and reference values were calculated for predefined intervals of gestational age in uncomplicated and complicated pregnancies using a random‐effects model described by DerSimonian and Laird.ResultsTwenty‐nine studies met the inclusion criteria and were included in the analysis. As early as the first trimester, GFR was increased by up to 40–50% in physiological pregnancy when compared with non‐pregnant values. Inulin clearance in uncomplicated pregnancy was highest at 36–41 weeks, with a 55.6% (53.7; 95% CI, 44.7–62.6 mL/min) increase when compared with non‐pregnant values, and creatinine clearance was highest at 15–21 weeks' gestation, with a 37.6% (36.6; 95% CI, 26.2–46.9 mL/min) increase. Decrease in serum creatinine level in uncomplicated pregnancy was most prominent at 15–21 weeks, with a 23.2% (−0.19; 95% CI, −0.23 to −0.15 mg/dL) decrease when compared with non‐pregnant values. Eight studies reported on pregnancies complicated by a hypertensive disorder. Meta‐regression analysis showed a significant difference in all kidney function parameters when comparing uncomplicated and hypertensive complicated pregnancies.ConclusionsIn healthy pregnancy, GFR is increased as early as the first trimester, as compared with non‐pregnant values, and the kidneys continue to function at a higher rate throughout gestation. In contrast, kidney function is decreased in hypertensive pregnancy. © 2018 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.