Paauw Nina D, Luijken Kim, Franx Arie, Verhaar Marianne C, Lely A Titia
Department of Obstetrics, Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Utrecht 3584 CX, The Netherlands
Department of Obstetrics, Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Utrecht 3584 CX, The Netherlands.
Clin Sci (Lond). 2016 Feb;130(4):239-46. doi: 10.1042/CS20150567.
Preeclampsia (PE) is a hypertensive pregnancy disorder complicating up to 1-5% of pregnancies, and a major cause of maternal and fetal morbidity and mortality. In recent years, observational studies have consistently shown that PE carries an increased risk for the mother to develop cardiovascular and renal disease later in life. Women with a history of PE experience a 2-fold increased risk of long-term cardiovascular disease (CVD) and an approximate 5-12-fold increased risk of end-stage renal disease (ESRD). Recognition of PE as a risk factor for renal disease and CVD allows identification of a young population of women at high risk of developing of cardiovascular and renal disease. For this reason, current guidelines recommend cardiovascular screening and treatment for formerly preeclamptic women. However, these recommendations are based on low levels of evidence due to a lack of studies on screening and prevention in formerly preeclamptic women. This review lists the incidence of premature CVD and ESRD observed after PE and outlines observed abnormalities that might contribute to the increased CVD risk with a focus on kidney-related disturbances. We discuss gaps in current knowledge to guide optimal screening and prevention strategies. We emphasize the need for research on mechanisms of late disease manifestations, and on effective screening and therapeutic strategies aimed at reducing the late disease burden in formerly preeclamptic women.
子痫前期（PE）是一种妊娠期高血压疾病，使高达1%-5%的妊娠复杂化，是孕产妇和胎儿发病及死亡的主要原因。近年来，观察性研究一致表明，PE会增加母亲日后患心血管和肾脏疾病的风险。有PE病史的女性患长期心血管疾病（CVD）的风险增加两倍，患终末期肾病（ESRD）的风险增加约5至12倍。将PE视为肾病和CVD的危险因素，有助于识别出有患心血管和肾脏疾病高风险的年轻女性群体。因此，当前指南建议对曾患子痫前期的女性进行心血管筛查和治疗。然而，由于缺乏对曾患子痫前期女性的筛查和预防研究，这些建议基于的证据水平较低。本综述列出了PE后观察到的过早发生CVD和ESRD的发生率，并概述了可能导致CVD风险增加的观察到的异常情况，重点关注与肾脏相关的紊乱。我们讨论了当前知识中的差距，以指导最佳的筛查和预防策略。我们强调需要研究晚期疾病表现的机制，以及旨在减轻曾患子痫前期女性晚期疾病负担的有效筛查和治疗策略。
