“You just forget about preeclampsia and move on” –awareness of chronic disease risks and follow-up preferences after preeclampsia in Ireland: a national qualitative study

BACKGROUND: Preeclampsia is associated with increased long-term risks of cardiovascular disease, kidney disease, and stroke. International guidelines recommend structured follow-up care to prevent chronic disease, but limited research has explored women's knowledge of these risks, and their preferences regarding long-term follow-up care. This may impede how obstetric information is used for chronic disease prevention in practice. METHODS: This qualitative study used purposive and snowball sampling to recruit women in Ireland diagnosed with preeclampsia at least one year prior. Semi-structured interviews were conducted online, exploring awareness of chronic disease risks and provision of follow-up care. Thematic analysis was performed using an inductive approach. RESULTS: Twelve women aged 28-64 years were interviewed, at median six years since preeclampsia diagnosis. Participants' antenatal and postnatal care experiences varied widely, but most described follow-up care after preeclampsia as being inconsistent or absent. Three key themes were generated: (1) Preeclampsia in the 'rear-view mirror'-women often viewed preeclampsia as an acute, resolved event, and had limited awareness of any long-term risks. However, they regarded chronic disease risk information as valuable and empowering; (2) Changing priorities as 'life takes over'- women often prioritised other family members' health needs above their own, particularly in the newborn phase. They favoured delaying discussions about chronic disease risks, ideally to 6-12 months after pregnancy, preferably provided through primary care; (3) Desire for proactive, 'blameless' follow-up care-women favoured systematic, non-judgmental follow-up programmes underpinned by clear communication between obstetric and primary care services, continuity of healthcare providers, and free access. Some described residual anxiety relating to their preeclampsia experience, and emphasised the importance of sensitive, person-centred follow-up care. CONCLUSION: Women affected by preeclampsia in Ireland typically have limited awareness of its links with long-term chronic disease risks, and frequently experience a lack of structured follow-up care. They expressed strong support for receiving personalised information about opportunities for secondary prevention, and advocated for systematic, proactive follow-up. Participants emphasised that future models of care should be pragmatic, person-centred, and include default enrolment for all women.