Long-term complications of preeclampsia

Preeclampsia is a multi-organ syndrome of pregnancy, defined by the new onset of hypertension and proteinuria after 20 weeks' gestation. This working definition ignores the variable multi-organ involvement of a syndrome that can include seizures in the absence of hypertension, or fulminating hepatic necrosis in the absence of proteinuria. These disparate clinical features are akin to an accelerated metabolic syndrome with widespread maternal endothelial dysfunction in the presence of a relatively underperfused placenta. Delivery of the placenta remains the only cure, but years after a pregnancy complicated by preeclampsia, women are at increased risk of chronic hypertension, diabetes mellitus, ischemic heart disease, cerebrovascular disease, kidney disease, thromboembolism, hypothyroidism, and even impaired memory. This article describes how pregnancy propels vulnerable women toward preeclampsia and how a brief, usually single, episode of this acute pregnancy syndrome defines those vulnerable to chronic disease in later life.