As perhaps expected, women with HELLP syndrome have a substantive risk for recurrence in subsequent pregnancies. In two studies, the risk ranged from 5 to 26 percent, but the true recurrence risk likely lies beween these two extremes (Habli, 2009; Sibai, 1995). Even if HELLP syndrome does not recur with subsequent pregnancies, again incidences of preterm delivery, fetal-growth restriction, placental abruption, and cesarean delivery are increased (Habli, 2009; Hnat, 2002).
Evidence has accrued that the preeclampsia syndrome is a marker for subsequent long-term cardiovascular and related morbidity and mortality (Table 40-16). hus, women with hypertension identified during pregnancy should be evaluated during the first several months postpartum. he working group of the NHBPEP (2000) concluded that hypertension attributable to pregnancy should resolve within 12 weeks of delivery. Hypertension persisting beyond this time is considered chronic (Chap. 50, p. 976). he Magpie Trial Follow-Up Collaborative Group (2007) reported that 20 percent of 3375 preeclamptic women seen at a median of 26 months postpartum had hypertension. Importantly, even if hypertension does not persist in the short term, convincing evidence suggests a higher risk for long-term cardiovascular morbidity.
Any hypertension during pregnancy is a risk marker for morbidity and mortality in later life (American College of Obstetricians and Gynecologists, 2013; Bellamy, 2007). In a case-control study from Iceland, Arnadottir and associates (2005) reported
TABLE 40-16. Some Long-Term Consequences in Women with Preeclampsia Syndrome the prevalences of ischemic heart disease-24 versus 15 percent, and stroke-9.5 versus 6.5 percent, were significantly increased in women who had gestational hypertension compared with normotensive controls. In a Swedish population study of more than 400,000 women, those with recurrent preeclampsia have systolic dysfunction and a greater incidence of ischemic heart disease (Valensise, 2016). Diastolic dysfunction is also more common (Bokslag, 2017). Preeclampsia is also a risk for coronary artery calciication and idiopathic cardiomyopathy (Behrens, 2016; White, 2016).
Lyke and associates (2009a) cited indings from a Danish registry of more than 780,000 nulliparas. After a mean followup of almost 15 years, the incidence of chronic hypertension was fivefold higher in those who had gestational hypertension, 3.5-fold greater after mild preeclampsia, and sixfold higher after severe preeclampsia. After two hypertensive pregnancies, this incidence rose sixfold. Moreover, these women with pregnancy-associated hypertension are at increased risk for ype 2 diabetes (Rice, 2016). And, preeclampsia is a risk factor for later diabetic retinopathy and retinal detachment (Auger, 2017; Beharier,r2016).
As emphasized by several investigators, other cofactors or comorbidities are related to acquisition of these long-term adverse outcomes (Gastrich, 2012; Harskamp, 2007; Hermes, 2012; Spaan, 2012b). These include the metabolic syndrome, diabetes, obesity, dyslipidemia, and atherosclerosis (Kajantie, 2017; Orabona, 2016; Stekkinger, 2015).