PROGNOSIS

Preeclampsia typically resolves within several days postpartum, but symptoms can sometimes persist for weeks or more. Patients should be carefully monitored for the duration of their postpartum hospitalization and may require continued antihypertensive therapy for several weeks after discharge.

Women who experience preeclampsia are at increased risk for recurrence in subsequent pregnancies. In general, women with more severe disease are at greater risk for recurrence. These women are also at elevated risk for developing metabolic syndrome and cardiovascular disease later in life, which may reflect either underlying endothelial dysfunction or permanent cardiovascular sequelae associated with preeclampsia. There is a slight increase in the risk of end-stage renal disease compared to the rest of the population, although the absolute risk is still low.

PREVENTION

A number of therapies have been used in attempts to prevent or slow the progression of preeclampsia, so far with little success. The drug with the most data is aspirin, which may exert its benefit by altering the abnormal prostaglandin-thromboxane ratios associated with endothelial dysfunction. Although many trials have shown no benefit of aspirin, a recent meta-analysis suggested that if started before 16 weeks of gestation, it may diminish the incidence and/or severity of pre-eclampsia in high-risk patients. Agents such as vitamin D, antioxidants, and sildenafil have been examined but have so far failed to show any protective effect.

Several tests to identify the patients at highest risk for preeclampsia have been investigated, including uterine artery Doppler ultrasound and measurement of VEGF, sFlt-1, and other angiogenic factors in blood and urine. Although these tests show some promise, at present they have limited usefulness because there is no way to prevent the emergence or progression of pre-eclampsia. Thus early detection through frequent screening of blood pressure and urine protein is of utmost importance, especially in high-risk patients. Educating patients about symptoms that may be potential warning signs is also valuable.