The Long Shadow of Pre-eclampsia: Why Follow-up Screenings Matter

Pre-eclampsia is a condition that occurs during pregnancy, leading to raised blood pressure, which can result in organ damage or failure and be life-threatening to both mother and baby. It is caused by a problem with the blood vessels which prevents the placenta from developing properly. Pre-eclampsia can occur even when the mother is completely healthy, but any underlying illness, such as existing high blood pressure (hypertension), makes it more likely to occur.  

After the pregnancy, symptoms of pre-eclampsia disappear, and current local clinical guidelines don’t mandate any follow-up screenings long-term. However, these women are at high risk for early- onset of hypertension, heart disease (cardiovascular disease) and kidney failure. These conditions can manifest at any point in the months or years after the pregnancy. 

Associate Professor Erika Jones from the Division of Nephrology and Hypertension in the Department of Medicine and PhD researcher Dr Bianca Davidson are working to show that regular screening of these women could be a life-changing intervention.   

 Long-term risks of pre-eclampsia 

“Women with pre-eclampsia have a 50% increased risk of high blood pressure by about 40 years of age,” said Associate Professor Jones. “This is younger than average and occurs before it is common to start screening for high blood pressure and cardiovascular disease.” 

Kidney failure is another high-risk factor for women who experience pre-eclampsia during pregnancy. Jones, as a kidney specialist, works in the Department of Medicine’s Renal Unit, at Groote Schuur Hospital. She said they found, in the renal service, that about 17% of the women who came in with end-stage kidney disease had experienced high blood pressure during pregnancy, characteristic of pre-eclampsia. 

To better understand the long-term prevalence of kidney damage, high blood pressure, and cardiovascular disease in women with pre-eclampsia, Jones and Davidson are undertaking a clinical and research intervention. This intervention also forms the basis of Davidson’s PhD research. They will follow up women who experienced severe pre-eclampsia during pregnancy at three months postpartum and then annually thereafter.  

“We screen women at three months after the pregnancy and then yearly thereafter. Our service also offers education and treatment for any condition identified at follow-up,” said Jones. For those who are healthy we still monitor and educate them annually for five years.” 

“The results from our research so far are alarming, the rates of ongoing hypertension and kidney dysfunction were much higher than we expected,” said Davidson. They found that the average age of women experiencing pre-eclampsia was around 30 years.  At the one-year screening point after the pregnancy, 20% of women still had sustained kidney dysfunction (chronic kidney disease) which is much higher than expected for their age. The proportion with ongoing hypertension post-pregnancy was disturbingly high with 44% at three months, 47% at one year and 45% at two years.  

“These results have encouraged us to campaign harder for more research in this field,” said Jones. 

Women’s health research: a neglected topic 

“We did struggle to get funding for research into the long-term consequences of pre-eclampsia, but we have persevered. The reality is we cannot ignore the high death toll of women from cardiovascular disease and hypertension,” said Jones. 

The reality is we cannot ignore the high death toll of women from cardiovascular disease and hypertension

Her comments echo sentiments of many women’s health research advocates, who note that research into women’s health issues is significantly underfunded compared to research issues that affect men. A report by the World Economic Forum and McKinsey Health Institute found that women spend 25% more of their lives in poor health compared to men. 

Through their work on pre-eclampsia Jones and Davidson are advocating for better screening and treatment for this high-risk group. 

“We are trying to challenge the thinking around pre-eclampsia,” said Jones. “Through our work we aim to demonstrate the long-term impacts of the condition. Additionally, we will advocate for appropriate follow-up and screening that can save the lives of countless women and relieve the pressure on the public healthcare system.”