Abstract
PurposeHypertensive disorders of pregnancy are still a leading cause of maternal and neonatal morbidity and mortality worldwide. Women with a history of preeclampsia have an increased risk for future cardiovascular and cerebrovascular disease, renal disease as well as diabetes mellitus. There is little knowledge on postpartum risk management. The aim of this study was to assess follow-up care for patients after pre-eclampsia or HELLP syndrome.MethodsThis questionnaire-based cross-sectional study aimed to evaluate the current recommendations of obstetricians in Austria regarding follow-up care, long-term risk counselling and risk of recurrence in future pregnancies after preeclampsia or HELLP syndrome. Data were collected using a survey, based on recommendations given by three substantial guidelines on hypertensive disorders of pregnancy, which was distributed via e-mail to 69 public obstetric departments in Austria. Each obstetric department was required to answer one questionnaire per local protocol.ResultsOur results revealed that of the 48 participating hospitals most obstetricians are aware of the importance of follow-up care for women after a pregnancy complicated by preeclampsia. Our data show that most physicians counselled patients about the future cardiovascular health risks associated with preeclampsia or HELLP syndrome (79.2%). Most obstetricians recommended lifestyle modification (77.1%) and continued blood pressure measurements (97.9%). All centers stated to counsel about the risk of recurrence (100%). However, counselling regarding follow-up care to exclude kidney damage (37.5%) and underlying diseases like thrombophilia (39.6%) were less prioritized.ConclusionsWe were able to show that counselling concerning the risk of long-term cardiovascular disease and risk of recurrence after a pregnancy complicated by preeclampsia or HELLP syndrome has been established in obstetric departments in public hospitals. Regarding the evaluation of underlying chronic diseases such as thrombophilia or renal disease, as well as counselling on the future risk of renal disease is still improvable according to our data. Further evaluation of follow-up care after hypertensive disorders of pregnancy in the outpatient and private sector and implementation of structured guidelines for follow-up, as well as screening for cardiovascular disease are necessary to ensure adequate risk management and to provide opportunities for prevention.
Highlights
Cardiovascular disease (CVD) is the most prevalent cause of death in women worldwide [1]
PE is a pregnancy-specific disorder defined by new-onset hypertension during pregnancy and at least one additional new-onset organ manifestation including proteinuria, thrombocytopenia, increased liver enzymes, neurological symptoms such as heachaches with visual disturbances, right upper quadrant abdominal pain and/or placental insufficiency manifesting in intrauterine growth restriction
Superimposed preeclampsia is defined as the new onset of one or more of the above features of preeclampsia occurring in addition to chronic hypertension during pregnancy [5]
Summary
Cardiovascular disease (CVD) is the most prevalent cause of death in women worldwide [1]. Even though the clinical manifestation of PE commonly ceases within few days after delivery, studies on maternal hemodynamic changes in women with HDP revealed persistent long-term cardiac alterations of up to 2 years after PE and increased lifetime risk of essential hypertension, cardiovascular disease and stroke [8–10], disturbances in renal function [11] as well as increased risk of developing diabetes [12]. Studies on maternal hemodynamic changes in women with PE revealed persistent long-term cardiac alterations of up to two years after PE and increased lifetime risk of essential hypertension and cardiovascular disease [9]. Long-term follow-up studies have revealed a high lifetime risk to develop cardiovascular disease as well as significantly higher cardiovascular mortality in cases of early-onset PE compared to women with a history of late-onset PE [2, 8, 10]. The overwhelming evidence that the obstetric history, history of HDP, offers a unique risk marker to identify young women at risk for future cardiovascular and renal disease, has resulted in the incorporation of PE and HELLP syndrome
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