A 36-year-old woman with pre-eclampsia delivered at 34 weeks. Six weeks postpartum, her blood pressure is 134/84 mmHg on two occasions, and urine dipstick shows trace protein. At her 12-week postpartum visit, blood pressure is 130/82 mmHg and proteinuria has resolved. Which of the following statements regarding her long-term risk is correct?

• A Her risk of chronic hypertension is the same as the general population
• B She has no increased risk of stroke unless she develops chronic hypertension
• C Her lifetime cardiovascular risk is unchanged because BP normalized by 12 weeks postpartum
• D She has approximately a 4-fold increased risk of ischemic heart disease compared to normotensive pregnancies ✓

Explanation

A history of pre-eclampsia confers a 3-4 fold increased lifetime risk of ischemic heart disease and a 2-fold risk of stroke and hypertension, independent of whether blood pressure normalizes postpartum. The American Heart Association recognizes pre-eclampsia as a sex-specific cardiovascular risk factor. Resolution of proteinuria by 12 weeks does not negate this risk. Women with pre-eclampsia should receive lifelong cardiovascular risk factor surveillance.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.