Short- and long-term prognosis of blood pressure and kidney disease in women with a past history of preeclampsia

Abstract

Little research has been conducted into the long-term effects of preeclampsia, despite its frequent occurrence. The aim of this review is to examine the association between preeclampsia and the development of hypertension and kidney diseases later in life. To achieve this aim, we evaluated three retrospective studies conducted in our department. In the first study, 52 women who suffered from preeclampsia during their first pregnancy were followed for 2 years after delivery for any long-term effects upon blood pressure. In the second study, we evaluated HOMA-R, pulse wave velocity and augmentation index in groups of 48 postmenopausal women with a past history of preeclampsia and 204 postmenopausal women without a past history of preeclampsia. In the third study, we examined the association between a past history of preeclampsia and chronic kidney disease based on biopsy in 127 postmenopausal women. From the first study, although there were no significant differences in age, blood pressure at the onset of preeclampsia, the levels of proteinuria and the birth weight of the child between women who remained hypertensive and those who became normotensive, body mass index was significantly larger in women who remained hypertensive compared to those who were normotensive. In the second study, we found that women with a past history of preeclampsia exhibited insulin resistance combined with reduced vascular elasticity. In the third study, of 32 patients with a past history of preeclampsia, 12 patients exhibited focal segmental glomerulosclerosis, 10 exhibited IgA nephropathy and 10 exhibited nephrosclerosis. In contrast, of the women without a past history of preeclampsia, 26 patients exhibited IgA nephropathy, 20 exhibited a minimal change in nephritic syndrome, 6 exhibited nephrosclerosis, 6 exhibited membranous nephropathy, 5 exhibited lupus nephritis, 5 exhibited diabetic nephropathy, and 27 exhibited various nephropathies. None of the women without a past history of preeclampsia exhibited focal segmental glomerulosclerosis. Taken together with previous results, these findings suggest that hypertension and chronic kidney disease in postmenopausal women are closely associated with a past history of preeclampsia.

Chronic kidney disease in postmenopausal women

“…In addition, the same group demonstrated that women were characterized by significantly elevated immunoreactive insulin levels but normoglycemia 17 years after a preeclamptic first pregnancy. 44 Similarly, in our previous study, 45 insulin resistance was apparent in women with a past history of preeclampsia and these findings supported by several studies that insulin resistance and the resultant hyperinsulinemia are causally related to hypertension and renal injury. [46][47][48] A number of potential mechanisms can account for these deleterious effects.…”

Hypertension in Pregnancy at the Teaching Hospital of Yalgado Ou?draogo, Burkina Faso

“…There is also a risk of progression towards chronic HPT in one quarter of the cases [9,28]. In fact, it is well known that up to 20% of women with hypertensive pregnancy disorders might persist with high BP levels after 6 weeks postpartum thus develop chronic hypertension [29][30][31].…”

Impaired sodium-dependent adaptation of arterial stiffness in formerly preeclamptic women: the RETAP-vascular study

“…Recent studies in fPE women have reported subtle vascular alterations such as arterial stiffness, as measured by pulsewave analysis (PWA) and pulse-wave velocity (PWV) (10,11,25,27,33,37,39,47,57). However, these studies show some inconsistencies; differences in study design, heterogeneity of the preeclamptic phenotype, and the presence or absence of comorbidities (i.e., hypertension and increased BMI) may explain the contradictory findings.…”

“…The enhanced risk could be the result of preexisting cardiovascular risk factors or longterm effects caused by preeclampsia itself (38,42,52). Since preeclampsia affects the maternal vascular bed, persistent vascular alterations in the postpartum period might potentially contribute to the increased cardiovascular risk of formerly preeclamptic women.Recent studies in fPE women have reported subtle vascular alterations such as arterial stiffness, as measured by pulsewave analysis (PWA) and pulse-wave velocity (PWV) (10,11,25,27,33,37,39,47,57). However, these studies show some inconsistencies; differences in study design, heterogeneity of the preeclamptic phenotype, and the presence or absence of comorbidities (i.e., hypertension and increased BMI) may explain the contradictory findings.…”