Preeclampsia 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 preeclampsia 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 preeclampsia 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 28-34 weeks, risk of recurrence in future pregnancies is about 33%; if birth was at 34-37 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 preeclampsia have an increased long-term risk of cardiovascular disease, including hypertension and stroke, type 2 diabetes, and renal disease.[102]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
[103]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
[104]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
[105]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
[106]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
[107]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
[108]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
[109]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
[110]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
[111]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
[112]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 preeclampsia 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.[113]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 preeclampsia. However, regular evaluation of their risk for cardiovascular disease, including previous preeclampsia 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
[114]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