Preeclampsia poses clear, mortal risks to mother and fetus during pregnancy, but the long-term complications are less certain. In a retrospective cohort study, based on data from the Medical Birth Registry of Norway and the Norwegian Renal Registry, researchers sought to determine whether preeclampsia is associated with risk for end-stage renal disease (ESRD). Data were available for 570,433 women who had delivered singleton infants at
16 weeks’ gestation from 1967 to 1991; information included infants’ gestational ages, infants’ birth weights, maternal preexisting renal disease, and diagnoses of preeclampsia. ESRD was defined based on receipt of dialysis or kidney transplant.Overall, 477 women with at least one pregnancy developed ESRD. Preeclampsia during the first pregnancy was associated with risk for ESRD (relative risk, 4.7; 95% confidence interval, 3.6–6.1) that was diagnosed a mean of 17 years later. Women who had been pregnant three or more times and who experienced two or three episodes of preeclampsia were at notably higher risk for ESRD (RR, 15.5; 95% CI, 7.8–30.8) compared with women who had a similar number of uneventful deliveries. These effects persisted after excluding women with preexisting kidney disease, essential hypertension, diabetes mellitus, or rheumatic disease. Delivering a preterm or low-birth-weight infant also was associated with higher risk for ESRD.
Comment: Although relative risks for ESRD among women who had experienced preeclampsia were high, absolute risk was low (3.7 events per 100,000 women annually); however, this study might involve a more homogeneous population with less risk for ESRD than that seen by many U.S. clinicians. The cardiovascular dysfunction and renal dysfunction that are hallmarks of preeclampsia support the idea that ESRD is a long-term consequence of the disease; the results of this large, retrospective study provide clinical evidence for that hypothesis. Clinicians would be wise to note histories of preeclampsia in their patients, keeping in mind that these women might require screening for renal disease later in life.
— Sandra Ann Carson, MD
Published in Journal Watch Women's Health August 20, 2008