Screenings if you have had preeclampsia
Preeclampsia and gestational hypertension (new high blood pressure after the 20th week of pregnancy) usually settle after the birth, but they raise the chance of high blood pressure and heart disease later in life. (MedlinePlus)(NICE NG133) This page covers the checks guidance lists in the years after, on top of routine screening, not treatment. For the checks in the first weeks after the birth, see screenings after pregnancy; for screening during pregnancy, see preeclampsia screening.
The main guidance
In the UK, NICE guideline NG133 on hypertension in pregnancy covers care after the birth and advice on long-term risk. (NICE NG133) In the US, the 2019 ACC/AHA prevention guideline and the 2018 AHA/ACC cholesterol guideline list a history of preeclampsia as a factor that raises heart risk. (ACC/AHA prevention, 2019)(AHA/ACC cholesterol, 2018) A 2021 American Heart Association scientific statement says adverse pregnancy outcomes, including hypertensive disorders of pregnancy, raise the risk of heart disease risk factors and of later coronary heart disease, stroke, peripheral vascular disease and heart failure, and that they should be recognised when heart risk is evaluated in women. (AHA, 2021) ACOG says people with hypertensive disorders should be counseled on timely follow-up with their obstetric or primary care provider, and that the provider who will take over their ongoing care should be named during the postpartum period. (ACOG, 2018)
Checks the guidance lists
| Check | When | Source |
|---|---|---|
| Postnatal medical review, with a urine test for protein after preeclampsia | 6 to 8 weeks after the birth | (NICE NG133) |
| Kidney function review | At 3 months, only if protein is still in the urine at 6 to 8 weeks | (NICE NG133) |
| Comprehensive postpartum visit | No later than 12 weeks after the birth | (ACOG, 2018) |
| Discussion of long-term heart risk with a GP or specialist | After the birth | (NICE NG133) |
| Heart risk factors (age 20 to 39) | At least every 4 to 6 years, for all adults | (ACC/AHA prevention, 2019) |
| 10-year heart risk (age 40 to 75), with preeclampsia counted as a risk-enhancing factor | Routinely | (ACC/AHA prevention, 2019)(AHA/ACC cholesterol, 2018) |
Blood pressure
NICE table 6 says that, compared with women who did not have a hypertensive disorder of pregnancy, the risk of later high blood pressure is about 2 to 5 times higher after preeclampsia and about 2 to 4 times higher after gestational hypertension. (NICE NG133) MedlinePlus says gestational hypertension usually goes away within 12 weeks after childbirth but raises the risk of high blood pressure in the future. (MedlinePlus) NICE advises discussing how to lower the risk of cardiovascular disease, including high blood pressure, with a GP or specialist. (NICE NG133) See blood pressure screening, blood pressure readings and screenings if you have high blood pressure.
Kidneys
NICE offers everyone who had preeclampsia a medical review 6 to 8 weeks after the birth, with a urine test strip for protein. If protein (1+ or more) is still present, it offers a further review at 3 months to assess kidney function, and suggests considering a specialist kidney assessment if that is abnormal. (NICE NG133) If there is no protein and no high blood pressure at the 6 to 8 week review, NICE says the relative risk of end-stage kidney disease is raised but the absolute risk is low, and no further kidney follow-up is needed. (NICE NG133) See kidney disease screening and kidney test results.
Heart risk, cholesterol and blood sugar
NICE says that after preeclampsia the risk of stroke is about 2 to 3 times higher, the risk of a major cardiovascular event about 1.5 to 3 times higher and the risk of cardiovascular death about 2 times higher. It does not report absolute risks, because these vary with follow-up time (1 to 40 years after the birth in the studies). (NICE NG133) The 2019 ACC/AHA prevention guideline says it is reasonable to assess traditional heart risk factors at least every 4 to 6 years in adults aged 20 to 39, and to calculate 10-year heart risk routinely from age 40 to 75. It names a history of preeclampsia among the factors that can raise risk beyond the calculated score. (ACC/AHA prevention, 2019) The 2018 AHA/ACC cholesterol guideline lists a history of preeclampsia as a risk-enhancing factor used when 10-year risk is borderline or intermediate. (AHA/ACC cholesterol, 2018) MedlinePlus lists diabetes among the later problems linked with preeclampsia. (MedlinePlus preeclampsia) See heart screenings by age, cholesterol test by age and A1C and blood sugar results.
Before another pregnancy
NICE suggests pre-pregnancy counselling for women who had preeclampsia or hypertension with a birth before 34 weeks, to discuss the risk of it happening again. It says the chance of recurrence rises when the gap between pregnancies is more than 10 years, and that women who had preeclampsia should not be routinely screened for thrombophilia. (NICE NG133) See pregnancy screenings by week.
Routine age-based screening
These checks are added to, not instead of, the routine screenings for your age; see screenings by age and gender.
When to contact a provider
MedlinePlus, preeclampsia, when to contact a medical professional: (MedlinePlus preeclampsia)
- Contact your provider if you have symptoms of preeclampsia during your pregnancy or after delivery.
Where they differ:
- How far kidney follow-up goes. NICE stops kidney follow-up when there is no protein in the urine and no high blood pressure at 6 to 8 weeks; (NICE NG133) MedlinePlus lists kidney disease among the later problems after preeclampsia without naming a check. (MedlinePlus preeclampsia)
- How the history is used. NICE advises telling women about the higher lifetime risk and discussing it with a GP or specialist; (NICE NG133) the US guidelines count preeclampsia as a risk-enhancing factor inside the 10-year heart risk assessment from age 40. (ACC/AHA prevention, 2019)(AHA/ACC cholesterol, 2018)
- Set intervals. None of these sources sets a yearly blood pressure, cholesterol or blood sugar test just because of preeclampsia; the ACC/AHA interval of every 4 to 6 years from age 20 applies to all adults. (NICE NG133)(ACC/AHA prevention, 2019)
Your doctor decides what your result means for you.
Questions people ask
Does preeclampsia affect my health after the pregnancy?
MedlinePlus says a history of preeclampsia raises the risk of heart disease, diabetes, kidney disease, chronic high blood pressure and preeclampsia in later pregnancies. NICE says a hypertensive disorder of pregnancy is linked with a higher risk of high blood pressure and cardiovascular disease later in life. (MedlinePlus preeclampsia) (NICE NG133)
How much higher is the risk?
NICE table 6 says that after preeclampsia the risk of high blood pressure is about 2 to 5 times higher, the risk of stroke about 2 to 3 times higher and the risk of a major cardiovascular event about 1.5 to 3 times higher than for women who did not have a hypertensive disorder of pregnancy. It does not give absolute risks, because these vary with follow-up time. (NICE NG133)
Do I need kidney checks for years afterwards?
NICE says that if there is no protein in the urine and no high blood pressure at the 6 to 8 week postnatal review, the absolute risk of end-stage kidney disease is low and no further kidney follow-up is needed. If protein is still present at 6 to 8 weeks, it offers a further review at 3 months to assess kidney function. (NICE NG133)
Does preeclampsia change my cholesterol or heart risk check?
The 2018 AHA/ACC cholesterol guideline and the 2019 ACC/AHA prevention guideline list a history of preeclampsia as a risk-enhancing factor that is taken into account when 10-year heart risk is borderline or intermediate. (AHA/ACC cholesterol, 2018) (ACC/AHA prevention, 2019)
Should I be tested for clotting disorders (thrombophilia)?
NICE says not to routinely screen for thrombophilia in women who have had preeclampsia. (NICE NG133)