Differences in clinical presentation and pregnancy outcomes in antepartum preeclampsia and new-onset postpartum preeclampsia: Are these the same disorder?

Abstract

ObjectiveNew-onset postpartum preeclampsia is a poorly defined condition that accounts for a significant percentage of eclampsia cases. It is unclear whether new-onset postpartum preeclampsia is a different disorder from or belongs to the same spectrum of classic antepartum preeclampsia. The objective of this study was to compare the clinical presentation and pregnancy outcomes of antepartum preeclampsia and new-onset postpartum preeclampsia.MethodsA retrospective study including 92 patients with antepartum preeclampsia and 92 patients with new-onset postpartum preeclampsia was performed. Clinical presentation and pregnancy outcomes were compared. Chi-square test was used to analyze categorical variables, and independent t-test and Mann-Whitney U-test for numerical variables. P-values of <0.05 were used to indicate statistical signifi cance.ResultsPatients with antepartum preeclampsia and new-onset postpartum preeclampsia differ significantly in profile, symptoms at presentation, laboratory markers and pregnancy outcomes.ConclusionNew-onset postpartum preeclampsia has a distinct patient profile and clinical presentation than antepartum preeclampsia, suggesting they may represent different disorders. Characterization of a patient profile with increased risk of developing this condition will help clinicians to identify patients at risk and provide early and targeted interventions to decrease the morbidity associated with this condition.

Hematobiochemical variability and predictors of new-onset and persistent postpartum preeclampsia

“…NOPPE and PPE are collectively termed postpartum PE. While some have reported that the prevalence of NOPPE ranges from 0.3 to 27.5% in the US 3 , 4 , another US study reported postpartum hypertension to be 63.2% 5 whereas in an African setting of Burkina Faso a prevalence of less than 2% was reported 6 .…”

Identification of Distinct Risk Factors for Antepartum and Postpartum Preeclampsia in a High-Risk Safety-Net Hospital

“…Only two prior studies have compared cases of late postpartum and antepartum preeclampsia; one found no difference in risk factors. (13) However, Vilchez (2016) found that women with late postpartum preeclampsia were significantly older, had higher gravity and parity, and were more likely to have public health insurance than those with antepartum preeclampsia, but found no difference in maternal race, body mass index, or mode of delivery. ( 14) These differences may be due to the inclusion of a comparison group with no preeclampsia or underlying differences in the populations.…”

“…13 However, Vilchez et al found that women with late PPPE were significantly older, had higher gravity and parity, and were more likely to have public health insurance than those with APE but found no difference in maternal race, body mass index, or mode of delivery. 14 These differences may be due to the inclusion of a comparison group with no PE or underlying differences in the populations. In an alternate approach, McLaren et al fit a predictive model for PPPE readmissions, including both patients with antepartum diagnoses and incident late postpartum diagnoses, identifying race/ethnicity, blood pressure at discharge, and PE diagnosis as the predictive of readmission with a Distinct Risk Factors for Antepartum and Postpartum Preeclampsia Picon et al…”

“…(9)(10)(11)(12) Limited evidence suggests that late postpartum preeclampsia may present with unique symptom profiles and, possibly, distinct risk factors compared to antepartum preeclampsia. (13,14) However, extant research has primarily compared patients with late postpartum preeclampsia to patients without hypertensive disorders using a case-control design, excluding patients with antepartum preeclampsia. (10,11) Identification of a distinct set of risk factors for late postpartum preeclampsia may help improve accurate identification of at-risk women, timely diagnosis and treatment, and maternal outcomes.…”

The link between hypertension and preeclampsia/eclampsia-life-long cardiovascular risk for women

“…Thus study conducted on 194 patients with eclampsia (92 antepartum and 92 postpartum) showed, that patients with postpartum preeclampsia were older, multiparous and of lower socio-economic status than patients with antepartum preeclampsia, additionally, patients with postpartum preeclampsia have more clinical symptoms like headache, elevated blood pressure, abnormal vision, nausea/vomiting, seizures, shortness of breath and pedal edema, they also show significantly higher laboratory markers, than patients with antepartum preeclampsia. And additionally, they more often require blood pressure treatment after discharge [34] .…”