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Pre-eclampsia Lifetime Cardiovascular CKD Risk — ESENeph MCQ

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ModeratePregnancy & RenalPre-eclampsia Lifetime Cardiovascular CKD RiskESENeph

A 37-year-old woman develops severe pre-eclampsia at 29 weeks' gestation. She delivers after receiving betamethasone. Postpartum, her creatinine falls from 160 to 95 umol/L over 2 weeks. Her proteinuria resolves. At 6-week postpartum review, she is normotensive off all medications. What long-term risk counselling is required?

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Correct answer: B — Increased lifetime risk of cardiovascular disease, chronic hypertension, and CKD

Pre-eclampsia is now recognised as a cardiovascular risk factor with lasting implications. Women with a history of pre-eclampsia have: 2-4x increased lifetime risk of chronic hypertension, 2x increased risk of ischaemic heart disease and stroke, 5-8x increased risk of cardiovascular mortality, and increased risk of CKD. NICE NG133 recommends annual BP monitoring and cardiovascular risk assessment for women with previous pre-eclampsia. Modifiable risk factors (weight, diet, exercise, smoking) should be addressed. In future pregnancies, aspirin from 12 weeks is indicated. The pre-eclampsia may unmask an underlying predisposition to endothelial dysfunction and metabolic syndrome. Renal function should be monitored long-term, as pre-eclampsia can cause subclinical renal injury.

Reference: NICE 2019 – NG133; Bellamy et al 2007 – Pre-eclampsia and CV Risk; ACOG 2019