Pre-eclampsia is a self-limiting condition of pregnancy that usually resolves once the placenta has been delivered, although it may persist for a few days post delivery. There are few long-term sequelae; however, there are some long-term disease associations.
Disease course
The course of pre-eclampsia is altered by treatment, and the condition can be controlled easily in most pregnant women, usually within a few hours of starting treatment. Once controlled, the length of the disease depends on when delivery is decided. After delivery, the condition normally settles within 2 to 4 days; however, some women have hypertensive problems and proteinuria for some weeks after.
Recurrence
The overall risk of recurrence of pre-eclampsia in subsequent pregnancies is approximately 16%.[16]National Institute for Health and Care Excellence. Hypertension in pregnancy: diagnosis and management. Apr 2023 [internet publication].
https://www.nice.org.uk/guidance/ng133
For women who gave birth at 28 to 34 weeks, risk of recurrence in future pregnancies is about 33%; if birth was at 34 to 37 weeks, risk is approximately 23%.[16]National Institute for Health and Care Excellence. Hypertension in pregnancy: diagnosis and management. Apr 2023 [internet publication].
https://www.nice.org.uk/guidance/ng133
Long-term disease associations
Women with pre-eclampsia have an increased long-term risk of cardiovascular disease, including hypertension and stroke, type 2 diabetes, and renal disease.[99]Heida KY, Bots ML, de Groot CJ, et al. Cardiovascular risk management after reproductive and pregnancy-related disorders: a Dutch multidisciplinary evidence-based guideline. Eur J Prev Cardiol. 2016 Nov;23(17):1863-79.
http://www.ncbi.nlm.nih.gov/pubmed/27432836?tool=bestpractice.com
[100]Wang Z, Wang Z, Wang L, et al. Hypertensive disorders during pregnancy and risk of type 2 diabetes in later life: a systematic review and meta-analysis. Endocrine. 2017 Mar;55(3):809-21.
http://www.ncbi.nlm.nih.gov/pubmed/27518283?tool=bestpractice.com
[101]Benschop L, Duvekot JJ, Versmissen J, et al. Blood pressure profile 1 year after severe preeclampsia. Hypertension. 2018 Mar;71(3):491-8.
http://www.ncbi.nlm.nih.gov/pubmed/29437895?tool=bestpractice.com
[102]Brouwers L, van der Meiden-van Roest AJ, Savelkoul C, et al. Recurrence of pre-eclampsia and the risk of future hypertension and cardiovascular disease: a systematic review and meta-analysis. BJOG. 2018 Dec;125(13):1642-54.
https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.15394
http://www.ncbi.nlm.nih.gov/pubmed/29978553?tool=bestpractice.com
[103]Stuart JJ, Tanz LJ, Missmer SA, et al. Hypertensive disorders of pregnancy and maternal cardiovascular disease risk factor development: an observational cohort study. Ann Intern Med. 2018 Aug 21;169(4):224-32.
http://www.ncbi.nlm.nih.gov/pubmed/29971437?tool=bestpractice.com
[104]Kristensen JH, Basit S, Wohlfahrt J, et al. Pre-eclampsia and risk of later kidney disease: nationwide cohort study. BMJ. 2019 Apr 29;365:l1516.
https://www.bmj.com/content/365/bmj.l1516.long
http://www.ncbi.nlm.nih.gov/pubmed/31036557?tool=bestpractice.com
[105]Khashan AS, Evans M, Kublickas M, et al. Preeclampsia and risk of end stage kidney disease: a Swedish nationwide cohort study. PLoS Med. 2019 Jul;16(7):e1002875.
https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002875
http://www.ncbi.nlm.nih.gov/pubmed/31361741?tool=bestpractice.com
[106]Behrens I, Basit S, Melbye M, et al. Risk of post-pregnancy hypertension in women with a history of hypertensive disorders of pregnancy: nationwide cohort study. BMJ. 2017 Jul 12;358:j3078.
https://www.bmj.com/content/358/bmj.j3078.long
http://www.ncbi.nlm.nih.gov/pubmed/28701333?tool=bestpractice.com
[107]Parikh NI, Gonzalez JM, Anderson CAM, et al. Adverse pregnancy outcomes and cardiovascular disease risk: unique opportunities for cardiovascular disease prevention in women – a scientific statement from the American Heart Association. Circulation. 2021 May 4;143(18):e902-16.
https://www.ahajournals.org/doi/10.1161/CIR.0000000000000961
http://www.ncbi.nlm.nih.gov/pubmed/33779213?tool=bestpractice.com
[108]O'Kelly AC, Michos ED, Shufelt CL, et al. Pregnancy and reproductive risk factors for cardiovascular disease in women. Circ Res. 2022 Feb 18;130(4):652-72.
https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.121.319895?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
http://www.ncbi.nlm.nih.gov/pubmed/35175837?tool=bestpractice.com
[109]Boucheron P, Lailler G, Moutengou E, et al. Hypertensive disorders of pregnancy and onset of chronic hypertension in France: the nationwide CONCEPTION study. Eur Heart J. 2022 Sep 14;43(35):3352-61.
https://academic.oup.com/eurheartj/article/43/35/3352/6395270
http://www.ncbi.nlm.nih.gov/pubmed/34643681?tool=bestpractice.com
However, there is currently a lack of understanding of pre-eclampsia subtypes, which include differences in the timing of onset in pregnancy, the presence of severe features and the association of intrauterine growth restriction. These features may have different long-term implications for cardiovascular risk.[110]Grandi SM, Filion KB, Yoon S, et al. Cardiovascular disease-related morbidity and mortality in women with a history of pregnancy complications. Circulation. 2019 Feb 19;139(8):1069-79.
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.118.036748?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
http://www.ncbi.nlm.nih.gov/pubmed/30779636?tool=bestpractice.com
There are no clear guidelines on the long-term follow-up of women who have had pre-eclampsia. However, regular assessment of their risk for cardiovascular disease, including previous pre-eclampsia and other hypertensive disorders of pregnancy alongside body mass index and other lifestyle factors, provides an opportunity for prevention interventions.[16]National Institute for Health and Care Excellence. Hypertension in pregnancy: diagnosis and management. Apr 2023 [internet publication].
https://www.nice.org.uk/guidance/ng133
[111]Wenger NK, Lloyd-Jones DM, Elkind MSV, et al. Call to action for cardiovascular disease in women: epidemiology, awareness, access, and delivery of equitable health care: a presidential advisory from the American Heart Association. Circulation. 2022 Jun 7;145(23):e1059-71.
https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000001071?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org
http://www.ncbi.nlm.nih.gov/pubmed/35531777?tool=bestpractice.com