What Happens to Women with Preeclampsia? Microalbuminuria and Hypertension Following Preeclampsia

EDITORIAL COMMENT: Ideally, all large obstetric institutions should have a special follow‐up clinic for women with early onset preeclampsia (before 37 weeks' gestation) and those with severe or recurrent preeclampsia of later pregnancy, especially when hypertension or proteinuria persist until the time of the woman's discharge from hospital. This paper examines the important question of the risk of diabetes following preeclampsia as well as confirming other reports that these women have a high incidence of microalbuminuria and hypertension. There is now great interest in detection of all women with gestational diabetes and their follow‐up after pregnancy to see if intervention by diet, exercise and/or drug therapy can lessen the rate of development of diabetes mellitus and its vascular complications. Ihle et al (A) reported on a follow‐up of 84 women with early‐onset preeclampsia, and renal biopsies were performed in 45 with glomerular haematuria. IgA glomerulonephritis was found in 25 women, non‐IgA mesangial proliferative glomerulonephritis in 14, and morphological changes consistent with diabetic nephropathy were found in 3 women who had had gestational diabetes in addition to early onset preeclampsia; glucose tolerance was normal in I and impaired in the other 2 (WHO criteria) when tested 6 weeks after delivery. Now that most major hospitals screen all women for gestational diabetes in the third trimester we should be able to unravel the associations that exist between abnormal glucose tolerance, preeclampsia and later cardiovascular and renal disease, and the development of diabetes mellitus. We require much more data concerning the risk of vascular disease in women with impaired glucose tolerance and whether therapeutic intervention can prevent development of these complications. Readers are referred to a recent relevant paper Summary: There is little published data on the incidence of remote hypertension, microalbuminuria (a possible marker of remote cardiovascular events) and diabetes following preeclampsia. This is of particular importance in Pacific Island populations as they have a high rate of preeclampsia, non‐insulin dependent diabetes and cardiovascular related deaths. The aim of mis study was to compare the rate of microalbuminuria and hypertension in 50 Samoan women with past preeclampsia (cases) with 50 Samoan women who did not have past preeclampsia (controls). Forty per cent of cases were hypertensive at follow‐up compared to 2% in the control group (p<0.0001). Microalbuminuria or proteinuria occurred in 40% of women with past preeclampsia and 18% of controls (p<0.02). Half of the cases with microalbuminuria were hypertensive. No case or control had an elevated fructosamine, suggesting that current diabetes was an unlikely explanation for the microalbuminuria. We conclude that Samoan women with past preeclampsia are at increased risk of developing chronic hypertension and microalbuminuria. The significance of the microalbuminuria after preeclampsia is not known, but it may be a marker of either remote cardiovascular morbidity or non‐insulin dependent diabetes. This study raises long‐term health implications for women with preeclampsia.