J SCHROERS1, R SHANMUGALINGAM 1,2,3,4, G LEE 3, A MAKRIS 1,2,3,4
1Department of Renal Medicine, South West Sydney Local Health District, , Australia, 2School of Medicine, Western Sydney University, , Australia, 3Women’s Health Initiative Translational Unit, Ingham Institute, SWSLHD, , Australia, 4SWS School of Medicine, University of New South Wales, , Australia
Background: Hypertensive disorders of pregnancy (HDP) are associated with higher risks of long-term cardiovascular, cerebrovascular, and renal outcomes in observational studies. Biomarkers, including the ratio of soluble fms-like tyrosine kinase 1 (sFlt1) to Placental Growth Factor (PlGF), are predictive of the short-term development of preeclampsia. The relationship between biomarker levels and long-term outcomes has not been studied. Aims: To determine the prevalence of cardiovascular, cerebrovascular and renal outcomes at 10 years in a cohort of women with previous HDP and to assess for correlation between biomarkers at the time of HDP and primary outcomes. Methods: A retrospective cohort study of 117 women diagnosed with HDP in South Western Sydney (SWS) between 2008 and 2009 was conducted. Medical records were audited to ascertain outcomes at 10 years remote from HDP. Plasma collected at the time of diagnosis were analysed for sFlt1, PlGF, soluble endoglin (sEng) and neutrophil gelatinase associated lipocalin (NGAL). Results: There was an 8.0% prevalence of cardiovascular and cerebrovascular disease, a 42.5% prevalence of hypertension, a 12.4% prevalence of chronic kidney disease (CKD) and a 12.4% prevalence of diabetes. A diagnosis of preeclampsia conferred a greater risk of the combined endpoint (MACE, stroke, TIA or CKD) (adjusted OR 3.22 95% CI 2.48 – 254.65, p-value 0.006) and CKD (OR 2.55 95% CI 1.61 – 101.14, p-value 0.02). There was no correlation between biomarkers and the development of primary outcomes. Conclusions: Women in SWS with previous preeclampsia had high rates of cardiovascular, cerebrovascular, metabolic and renal outcomes at 10-year follow-up, with no correlation between biomarkers at the time of HDP and long-term outcomes.
Dr Jade Schroers is a final year nephrology advanced trainee who has trained at Royal Prince Alfred, Liverpool, Bankstown, Campbelltown hospitals. She has an interest in pregnancy medicine and long-term outcomes for patients from lower socioeconomic settings.