Hypertension Management in Pregnancy and Postpartum

Area of Science:

• Obstetrics and Gynecology
• Nephrology
• Cardiology

Background:

• Hypertensive disorders of pregnancy affect 9% of US pregnancies, causing significant maternal morbidity and mortality.
• Chronic kidney disease is a major risk factor for preeclampsia; pregnancy can reveal undiagnosed kidney disease.
• The postpartum period, especially days 3-6, carries high risks for maternal death from cardiovascular causes.

Purpose of the Study:

• To review the diagnosis, pathophysiology, and management of hypertensive disorders throughout the peripartum period.
• To highlight the critical role of nephrologists in identifying and managing cardiorenal sequelae.
• To emphasize the postpartum visit as a key opportunity for intervention and prevention of long-term disease.

Main Methods:

• Literature review on hypertensive disorders of pregnancy, preeclampsia, and postpartum hypertension.
• Analysis of the intersection between pregnancy, kidney disease, and cardiovascular health.
• Focus on the nephrologist's role in peripartum care and long-term risk management.

Main Results:

• Hypertensive pregnancies accelerate the development of chronic hypertension, kidney disease, and cardiometabolic risks.
• Preeclampsia causes acute cardiorenal injury that may not fully resolve post-delivery.
• Postpartum hypertension is under-recognized but poses a significant risk for maternal mortality.

Conclusions:

• Nephrologists are crucial in managing cardiorenal risks associated with hypertensive pregnancies.
• The postpartum period is a critical, underutilized window for intervention to prevent chronic disease.
• Delivery should not be considered the endpoint for managing hypertensive disorders of pregnancy.