Overview 

Preeclampsia, a hypertensive disorder of pregnancy (HDP), can affect between 2-8% of pregnancies globally. Its primary clinical manifestations include high blood pressure, often accompanied by proteinuria and end-organ damage. Typically, diagnosis occurs during the antenatal period, after 20 weeks of gestation.¹ However, postpartum preeclampsia, which is diagnosed between 48 hours to 6 weeks after childbirth, is a less understood form of the condition but carries a heightened risk of maternal morbidity compared to antenatal preeclampsia.² It's crucial for expecting mothers and healthcare providers alike to be aware of these distinctions along with the risk factors and possible complications for the well-being of both mother and baby. 

What is postpartum preeclampsia?

Postpartum preeclampsia is a serious medical condition characterised by new-onset high blood pressure and other severe features that can occur between 48 hours to 6 weeks after childbirth. This condition is typically identified by a blood pressure reading of 140/90mmHg or higher, along with accompanying severe features such as:

• Proteinuria (high levels of protein in urine) 
• Thrombocytopenia (low platelet count) 
• Renal insufficiency (impaired kidney function)
• Impaired liver function 
• Additional symptoms like pulmonary oedema and persistent headaches that do not respond to treatment²

Common signs and symptoms of this condition include persistent headaches accompanied by blurry vision, eclampsia (seizures), shortness of breath, chest pain, and peripheral swelling. It's important to note that these symptoms of postpartum preeclampsia can arise even in the absence of any prior history of hypertension during pregnancy, which is the case in approximately 60% of women. Typically, women with this condition present within 7-10 days following childbirth, although it can extend up to 3 months postpartum.² 

The exact underlying cause of this disease is not well understood but ongoing research efforts persist in order to better understand postpartum preeclampsia.²

Risk factors for postpartum preeclampsia

The risk factors for postpartum preeclampsia closely mirror those associated with preeclampsia occurring during pregnancy. These factors include maternal age, with women over 35 years old facing nearly double the risk of developing postpartum preeclampsia. Additionally, individuals of Black race have a 2-4 fold increased risk, while maternal obesity (BMI greater than 40) and diabetes are linked to 7.7 fold and 3.5 fold increases in risk, respectively. A history of hypertension during pregnancy also elevates the risk, along with carrying multiple babies (twins or triplets).^1,2

While first-time childbirth is associated with a higher likelihood of preeclampsia during pregnancy, studies have not conclusively established a similar association with postpartum preeclampsia. Moreover, cesarean sections pose a greater risk compared to vaginal births, and higher rates of intravenous fluid (IV) infusion during labour are also associated with increased risk.² However, do keep in mind that any woman is still at risk regardless of the presence of these risk factors.

If you are pregnant or expecting and any of these factors concern you, speak to your OB-GYN who can properly advise you and provide appropriate care. 

Complications associated with postpartum preeclampsia

Postpartum preeclampsia can lead to various serious complications similar to those experienced in preeclampsia during pregnancy, although these effects do not typically impact the baby directly. Eclampsia, characterized by seizures, is a significant concern, with approximately 21% of eclamptic seizures occurring postpartum.² Severe seizures pose a small risk of brain damage or permanent disability.³ Other complications include pulmonary edema, thromboembolism, stroke, and in extreme cases, maternal death.^2,4 In fact, women with postpartum preeclampsia face a higher risk of severe maternal morbidity, with a 12.1% risk compared to 6.9% for those with preeclampsia during pregnancy.²

Furthermore, beyond immediate risks, postpartum preeclampsia is associated with long-term complications. Chief among these is a significantly elevated risk of developing cardiovascular diseases such as chronic hypertension or ischemic heart disease later in life.^1,2

Diagnosis and treatment of postpartum preeclampsia

Now that we've covered the risk factors and potential complications associated with postpartum preeclampsia, it's crucial to discuss its diagnosis and treatment, which are equally—if not more—important. When presenting with concerning symptoms, your healthcare provider will conduct a series of diagnostic tests. These may include a thorough medical history and physical examination, along with neurologic and cardiopulmonary assessments. Blood tests to assess liver and renal function, as well as urine tests, may also be performed. Depending on the clinical presentation, additional diagnostic tests may be necessary.^2,3

In cases of severe condition, hospitalisation for close monitoring may be required, while outpatient management is possible for milder cases.³

Treatment typically involves various approaches, including the administration of antihypertensive medication to control blood pressure, magnesium sulfate to prevent seizures, diuretics, and frequent monitoring of blood pressure levels.²

It's important to note that many women may not have a scheduled follow-up appointment with their OB-GYN until 2-6 weeks after delivery.² However, the first week post-delivery is a critical period for the development of postpartum preeclampsia. Therefore, any onset of symptoms during this time should be promptly reported to your healthcare provider. Timely identification and management of the condition can significantly improve outcomes and overall well-being.^2,5 Don't hesitate to reach out to your OB-GYN immediately if you experience any concerning symptoms. Your health and safety are of utmost importance.

Prevention

While there isn't much that can be done independently to prevent postpartum preeclampsia, maintaining a healthy and active lifestyle can significantly reduce the likelihood of developing risk factors such as obesity and type 2 diabetes. Incorporating regular exercise and a balanced diet into your routine can be beneficial.⁶

Additionally, if you have any identified risk factors, your healthcare provider may recommend a preventive measure such as low-dose aspirin (81 mg/day) during pregnancy. This medication has been shown to help lower blood pressure and reduce the risk of developing preeclampsia.⁷

Overall, while prevention may not be entirely within your control, taking proactive steps to live a healthy lifestyle and following medical advice can help mitigate the risk of postpartum preeclampsia and promote overall well-being during and after pregnancy.

Summary 

Understanding the complications and risks associated with postpartum preeclampsia is paramount for the health and well-being of both mothers and babies. This condition, though less recognised than its antenatal counterpart, presents significant dangers, often striking unexpectedly in the critical weeks following childbirth. By empowering mothers with knowledge about the symptoms, risk factors, and potential complications of postpartum preeclampsia, we can enable them to recognise signs early on and seek timely medical intervention. Equally important is the support provided by healthcare providers in offering appropriate care and monitoring. The importance of regular prenatal and postnatal check-ups cannot be overstated, especially for high-risk individuals. Additionally, efforts to prevent postpartum preeclampsia through lifestyle modifications and, when necessary, preventive measures prescribed by healthcare professionals are crucial steps toward safeguarding maternal health. By prioritising education, support, and proactive healthcare practices, we can work towards minimising the impact of postpartum preeclampsia and ensuring the well-being of mothers and their newborns.