Post-partum trend in blood pressure levels, renal function and proteinuria in women with severe preeclampsia and eclampsia in Sub-Saharan Africa: A 6-months cohort study

Abstract

BackgroundPreeclampsia and eclampsia, which are the most frequent hypertensive disorders in pregnancy, are associated with renal involvements. We aimed to assess the time trend in blood pressure levels, renal function and proteinuria after delivery, and investigate their determinants in Cameroonian women with severe preeclampsia and eclampsia.MethodsThis was a prospective cohort study involving 54 women with severe preeclampsia and eclampsia, conducted between July 2010 and February 2012 at the central maternity unit of the Yaoundé Central Hospital. Clinical and laboratory parameters were recorded from day-1 to 6 months after delivery. Mixed-linear and logistic regression models were used to relate baseline and within follow-up levels of covariates, with changes in blood pressure levels, renal function and proteinuria, as well as persisting hypertension, renal failure and proteinuria.ResultsDuring follow-up, a significant improvement was observed in blood pressure, renal function and proteinuria (all p < 0.002). Thirteen (24.1%) patients with renal failure at delivery recovered completely within six weeks. Twenty-six (48.1%), 17 (31.5%) and 1 (1.8%) patients had persisting proteinuria at 6 weeks, 3 months and 6 months post-delivery, respectively. Corresponding figures for persisting hypertension were 23 (42.6%), 15 (27.8%) and 8 (14.8%). Advanced age, higher body mass index, low gestational age at delivery, low fetal birth weight, and proteinuria at delivery were the main risk factors for persisting hypertension at 3 months, meanwhile low fetal birth weight, severe preeclampsia and proteinuria at delivery were correlated with persisting proteinuria at 3 months. Advanced age and higher body mass index were the only determinants of the composite outcome of persisting hypertension or proteinuria at three and six months.ConclusionHypertension and proteinuria are very common beyond the postpartum period in Cameroonian women with severe preeclampsia and eclampsia. Long-term follow-up of these women will help preventing and controlling related complications.

Prospective cohort study of persistent hypertension following pre-eclampsia at Medani Hospital, Sudan

“…The present study could have overestimated the incidence of persistent hypertension owing to the relatively short follow‐up (up to 6 weeks after delivery). The incidence of persistent hypertension following pre‐eclampsia has been demonstrated to decrease over time; in a previous study [17] persistent hypertension rates of 42.6%, 27.8%, and 14.8% were recorded at 6 weeks, 3 months, and 6 months after delivery, respectively. Persistent hypertension following pre‐eclampsia could be unrepresentative of the wider community because the patients included in these studies (pregnant women) undergo regular medical follow‐up, and similar rates of hypertension could be undetected among groups of individuals who are not monitored as closely, such as male patients and non‐pregnant women.…”

“…However, lower rates of persistent hypertension have been reported in Uganda (28%) [8] and among patients in an American study [16] that found 21% of patients with severe pre‐eclampsia experienced persistent hypertension 6 weeks after delivery. Conversely, a study in Cameroon reported that 42.6% of patients with severe pre‐eclampsia had persistent hypertension 6 weeks after delivery [17].…”

The impact of proteinuria on maternal and perinatal outcomes among women with pre‐eclampsia

“…Normalization of proteinuria should occur at up to 6 months after delivery among women with pre‐eclampsia; however, proteinuria or hypertension can persist for as long as 24 months postpartum. Women who presented with pre‐eclampsia and remain proteinuric after 6 months of delivery should be assessed for underlying chronic kidney disease …”

Clinical study on the factors affecting the post‐partum recovery of patients with hypertensive pregnancy disorders at a Chinese hospital

“…Women who develop PE are at a greater risk of cardiovascular and cerebrovascular events even years after their pregnancies. Despite this risk, few studies have focused on the recovery course of HDP . Indeed, data of post‐partum recovery of HDP is limited, particularly in China.…”