Proteinuria in Preeclampsia and Long-Term Risk of Maternal Kidney and Cardiovascular Disease: A Population-Based Cohort Study.

Abstract

To examine the association between urinary protein excretion (UPE) level in preeclampsia and long-term risk of maternal hypertension, chronic kidney disease (CKD), and cardiovascular disease (CVD). Nationwide, population-based cohort study utilising routinely collected individual-level data from medical databases. Denmark, 1998-2018, with follow-up through 2021. All pregnancies ≥ 20 weeks among women aged ≥ 15 years. We calculated cumulative incidences (risks) of hypertension, CKD, and CVD by preeclampsia status, including UPE level (no/mild versus moderate/severe, based on established urine protein/albumin cutoffs). Adjusted risk differences and risk ratios were computed for women with preeclampsia compared with those without, adjusting for age, smoking, obesity, residential region, and year. 10-year risk, adjusted risk difference, and risk ratio of hypertension, CKD and CVD by preeclampsia status and UPE level. Among 286 078 pregnant women, 9538 (3.3%) developed preeclampsia, which was associated with higher risks of later hypertension, CKD or CVD. Among women with preeclampsia with no/mild UPE, 10-year risks were 11.9% (95% CI: 10.9-13.0) for hypertension, 1.2% (95% CI: 0.9-1.6) for CKD and 1.1% (95% CI: 0.8-1.5) for CVD. With moderate/severe UPE, 10-year risks were 16.0% (95% CI: 14.6-17.5) for hypertension, 5.1% (95% CI: 4.3-5.9) for CKD and 1.2% (95% CI: 0.8-1.7) for CVD. For hypertension and CVD, adjusted risk differences and risk ratios were similar across UPE levels, whereas CKD risk increased with higher UPE. Preeclampsia is associated with increased long-term maternal risk of hypertension, CKD, and CVD. Higher UPE levels correlate with higher risk of later hypertension and CKD.