Long-Term Mortality After Preeclampsia

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Abstract
Many believe that preeclampsia is not associated with future morbidity or mortality. We sought to investigate the long-term risk of mortality in women with preeclampsia, focusing on those known to be subsequently normotensive. We ascertained deaths during 24–36 years’ follow-up in a cohort of 37,061 women who delivered in Jerusalem in 1964–1976, including 1,070 women with preeclampsia. We used Cox proportional hazard models to estimate the risk of mortality associated with preeclampsia while controlling for the woman's age and education, history of diabetes, heart disease and low birth weight birth, the husband's social class, and the calendar year at the start of follow-up. Compared with women who were not diagnosed with preeclampsia, the relative risk of death after preeclampsia was 2.1 (95% confidence interval = 1.8–2.5). Deaths from cardiovascular disease contributed most strongly to this increase. Among women with preeclampsia who had subsequent births without preeclampsia, the excess risk of mortality became manifest only after 20 years. These findings, together with other recent cohort studies, define preeclampsia as a risk marker for mortality from cardiovascular disease. They suggest that the observation of a normal blood pressure after preeclampsia should not discourage the search for other cardiovascular risk factors or abrogate the need for other preventive measures.