Resolution of Hypertension and Proteinuria After... : Obstetrics & Gynecology (original) (raw)

Original Research

Berks, Durk MD; Steegers, Eric A.P. MD, PhD; Molas, Marek MSc; Visser, Willy MD, PhD

From the Department of Obstetrics and Gynecology, Division of Obstetric and Prenatal Medicine, and the Department of Biostatistics, Erasmus MC Medical Centre, Rotterdam, The Netherlands.

Corresponding author: D. Berks, MD, Erasmus MC, Department of Obstetrics and Gynecology, Division of Obstetric and Prenatal Medicine, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands; e-mail: [email protected].

Financial Disclosure The authors did not report any potential conflicts of interest.

OBJECTIVE:

To estimate the time required for hypertension and proteinuria to resolve after preeclampsia, and to estimate how this time to resolution correlates with the levels of blood pressure and proteinuria during preeclampsia and prolonging pregnancy after the development of preeclampsia.

METHODS:

This is a historic prospective cohort study of 205 preeclamptic women who were admitted between 1990 and 1992 at the Erasmus MC Medical Centre, Rotterdam, The Netherlands. Data were collected at 1.5, 3, 6, 12, 18, and 24 months after delivery. Hypertension was defined as a blood pressure 140/90 mm Hg or higher or use of antihypertensive drugs. Proteinuria was defined as 0.3 g/d or more. Resolution of hypertension and proteinuria were analyzed with the Turnbull extension to the Kaplan-Meier procedure. Correlations were calculated with an accelerated failure time model.

RESULTS:

At 3 months postpartum, 39% of women still had hypertension, which decreased to 18% at 2 years postpartum. Resolution time increased by 60% (P<.001) for every 10-mm Hg increase in maximal systolic blood pressure, 40% (_P_=.044) for every 10-mm Hg increase in maximal diastolic blood pressure, and 3.6% (_P_=.001) for every 1-day increase in the diagnosis-to-delivery interval. At 3 months postpartum, 14% still had proteinuria, which decreased to 2% at 2 years postpartum. Resolution time increased by 16% (_P_=.001) for every 1-g/d increase in maximal proteinuria. Gestational age at onset of preeclampsia was not correlated with resolution time of hypertension and proteinuria.

CONCLUSION:

The severity of preeclampsia and the time interval between diagnosis and delivery are associated with postpartum time to resolution of hypertension and proteinuria. After preeclampsia, it can take up to 2 years for hypertension and proteinuria to resolve. Therefore, the authors suggest that further invasive diagnostic tests for underlying renal disease may be postponed until 2 years postpartum.

LEVEL OF EVIDENCE:

III