Preeclampsia: Postpartum Resolution of Hypertension, Proteinuria and Serum N-terminal B-type Natriuretic Peptide

Abstract

Background: Postpartum persistent proteinuria and hypertension (HT) is associated with development of chronic kidney disease and cardiovascular disease in later life. AIMS & OBJECTIVES: To evaluate blood pressure, proteinuria and serum NT-pro-BNP in proteinuric preeclamptic (PE) women and study their postpartum resolution till 3 months and determine the associated risk factors. Material and methods: 100 PE women enrolled included 66 women with mild (group A) and 34 with severe PE (group B). BP, urinary protein:creatinine(P/C) ratio, S.NT-pro-BNP were evaluated at labor room admission, postpartum day 1, 6 weeks and 3 months. Results: Group B women had significant higher baseline BP, urine P/C ratio and S. NT-pro-BNP compared to group A. Resolution of BP, proteinuria and S. NT-pro-BNP was complete in group A women at 6 weeks postpartum. Persistent hypertension was observed in 25 and 4 women at postpartum 6 weeks and 3 months respectively. Proteinuria persisted in 25 and 10 women at postpartum 6 weeks and 3 months respectively. Resolution of NT-pro-BNP was complete at 3 months. In logistic regression model persisting hypertension and proteinuria at 3 months was correlated with increasing age, higher BMI and lower gestational age at delivery. Negative predictive value of 100% was observed with baseline P/C ratio <5, BP <120 mm Hg diastolic and S.NT-pro-BNP <1000 pg/mL for development of persistent proteinuria and hypertension. Conclusion: Women with severe PE should be followed up for persistent proteinuria and hypertension. These women require evaluation for chronic kidney disease and preventive strategies for cardiovascular disease.

<p>Predictors of Postpartum Persisting Hypertension Among Women with Preeclampsia Admitted at Carlos Manuel de Cèspedes Teaching Hospital, Cuba</p>

“…22,25 High levels of serum creatinine were associated with persisting hypertension at twelve weeks postpartum among preeclampsia patients (aRR=1.35, 95% CI:1.241-3.606, p=0.032) at this hospital. This result was consistent with the one of Ndayambagye et al 4 in Mulago hospital in Uganda, Saini et al in India 26 as well as that by Babah et al 21 in Nigeria. Because raised serum creatinine is a known marker for chronic renal disease, it is possible that the women who had elevated serum creatinine had underlying kidney injury resulting from either the preeclampsia itself, or probably were previously undiagnosed asymptomatic patients of kidney disease, which per se is an independent predictor of the development and progression of persisting hypertension and its associated morbidity and mortality.…”

“…The greater frequency of persisting hypertension in women aged 35 years and more has also been recently hypothesized to result in increased release of angiogenic factors and abnormal placentation thus increasing susceptibility to severe preeclampsia and its sequelae such as persisting hypertension. Indeed, study results of Saini et al 26 and Levine et al 20 revealed that severe preeclampsia was an independent predictor of persisting hypertension postpartum. And the reverse is reportedly true for women with persisting hypertension.…”

“…Consistently also was the findings of Amougou et al 18 in Cameroon where old age of more than 40 years was independently associated with progression to persistent arterial hypertension in women with preeclampsia. The association between persisting hypertension and advancing age may be explained by various proposed pathophysiologic pathways related to the age mediated reduced elastic arterial compliance and increased peripheral resistance as suggested by Rohrscheib et al 25 Saini et al 26 and Lardoeyt et al 27 which puts them at higher risk of developing persisting hypertension. The greater frequency of persisting hypertension in women aged 35 years and more has also been recently hypothesized to result in increased release of angiogenic factors and abnormal placentation thus increasing susceptibility to severe preeclampsia and its sequelae such as persisting hypertension.…”

Ionic Liquid‐Directed Nanoporous TiNb2O7 Anodes with Superior Performance for Fast‐Rechargeable Lithium‐Ion Batteries

“…On the C HPXPS of 1000 cycled TNO700 electrode in Figure 4d, the peaks at 287.8 and 286.2 eV are assigned to C=O group and C-OH and C-O-C groups, [62,63] which are due the decomposition of carbonates during the cycling. Those aforementioned groups is also apparent on the O HRXPS of the 1000 cycled electrode, [13,[64][65][66] revealing the decomposition of carbonates. Additionally, the presence of LiF peak at 686.1 eV on the F HRXPS can be attributed to the side reaction of LiPF 6 salt.…”

Siamese Pumpkin Juice (Sechium Edule (Jacq.) Sw) To Decreased Blood Pressure Of Postpartum Mother's Hypertension

“…According to Unverdi S et al (Gupta et al, 2019), postpartum hypertension should be evaluated concerning sustained proteinuria, persistent hematuria, or impaired renal function. A percutaneous kidney biopsy should be performed on women with positive signs of kidney disease.…”