Effect of pregnancy prolongation in early-onset pre-eclampsia on postpartum maternal cardiovascular, renal and metabolic function in primiparous women: an observational study

BJOG. 2021 Jan;128(1):121-129. doi: 10.1111/1471-0528.16435. Epub 2020 Aug 13.

Abstract

Objective: To evaluate the association between deferred delivery in early-onset pre-eclampsia and offspring outcome and maternal cardiovascular, renal and metabolic function in the postpartum period.

Design: Observational study.

Setting: Tertiary referral hospital.

Population: Nulliparous women diagnosed with pre-eclampsia before 34 weeks' gestation who participated in a routine postpartum cardiovascular risk assessment programme. Women with hypertension, diabetes mellitus or renal disease prior to pregnancy were excluded.

Methods: Regression analyses were performed to assess the association between pregnancy prolongation and outcome measures.

Main outcome measures: Offspring outcome and prevalence of deviant maternal cardiovascular, renal and metabolic function.

Results: The study population included 564 women with a median pregnancy prolongation of 10 days (interquartile range [IQR] 4-18) who were assessed at on average 8 months (IQR 6-12) postpartum. Pregnancy prolongation after diagnosis resulted in a decrease in infant mortality (adjusted odd ratio [aOR] 0.907, 95% CI 0.852-0.965 per day prolongation). This improvement in offspring outcome was associated with an elevated risk of moderately increased albuminuria (aOR 1.025, 95% CI 1.006-1.045 per day prolongation), but not with aberrant cardiac geometry, cardiac systolic or diastolic dysfunction, persistent hypertension or metabolic syndrome.

Conclusion: Pregnancy prolongation in early-onset pre-eclampsia is associated with improved offspring outcome and survival. These effects do not appear to be deleterious to short-term maternal cardiovascular and metabolic function but are associated with a modest increase in risk of residual albuminuria.

Tweetable abstract: Pregnancy prolongation in pre-eclampsia has only a limited effect on postpartum maternal cardiovascular function.

Keywords: Albuminuria; cardiovascular health; deferred delivery; early-onset pre-eclampsia; hypertension; metabolic syndrome.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Albuminuria
  • Female
  • Humans
  • Metabolic Syndrome
  • Netherlands / epidemiology
  • Parity
  • Pre-Eclampsia / prevention & control*
  • Pregnancy
  • Pregnancy, Prolonged*
  • Prenatal Care*
  • Puerperal Disorders / epidemiology*
  • Puerperal Disorders / etiology
  • Regression Analysis
  • Risk Factors