August 25, 2008

Pregnancy Complication Could Be Sign of Problems to Come

By Liz Szabo

As anyone who has been pregnant can attest, the nine months spent carrying a baby can feel like a marathon.

But pregnancy may also be a test -- not of a woman's commitment to motherhood but of the fitness of her heart, blood vessels and kidneys, a new study suggests.

The study, in the current edition of The New England Journal of Medicine, finds that pregnant women who develop a serious complication called pre-eclampsia -- which can lead to strokes in the mother and death for the baby -- have four times the risk that women without the condition have of developing "end-stage" kidney failure years later.

Patients who have this kind of kidney failure need regular dialysis or a kidney transplant to survive.

Even among women with preeclampsia, the risk of kidney failure is less than 1%, says lead author Bjorn Vikse of University Hospital in Bergen, Norway.

For his study, Vikse examined medical records of 570,433 women in the Norwegian birth registry, a government database with information on all births since 1967. That's a far more extensive resource than anything available to researchers in the USA.

The stresses of pregnancy may reveal a body's vulnerabilities and give a woman an early warning that her heart and kidneys may not be as strong as they should be, Vikse says. For example, a woman's heart needs to pump 40% more blood while she is pregnant, and kidneys need to filter 40% more blood.

Doctors have long known that women who develop diabetes while pregnant are more likely to be diabetic after delivery, as well.

Studies also suggest that women with pre-eclampsia are more likely than others to develop several other problems later in life, including high blood pressure, stroke, heart disease and diabetes, according to an accompanying editorial by Ravi Thadhani and Caren Solomon of Massachusetts General Hospital.

Pre-eclampsia, which afflicts about 5% of pregnant women, can be dangerous. Women who have the condition develop sudden high blood pressure, severe swelling and protein in the urine. The only cure is to deliver the baby, which can lead to infants being born very early.

Although doctors don't completely understand why some women develop pre-eclampsia, Thadhani and Solomon say obesity, diabetes and a history of high blood pressure increase the risk.

More than 100,000 patients in the USA begin dialysis each year, the editorial says. High blood pressure and diabetes both increase the risk of kidney failure.

It makes sense that pre-eclampsia might increase the risk of kidney failure, Vikse says, because protein in the urine indicates that kidneys aren't working normally. Women who have pre-eclampsia also develop high blood pressure, which can damage the kidneys.

Although pre-eclampsia may reveal previously undetected health problems, it's also possible that it causes the injury to a woman's body, putting her at risk for future problems, the editorial notes.

Thadhani and Solomon say doctors should follow women who have pre-eclampsia closely so they can treat any health problems -- such as diabetes or high blood pressure -- before they cause permanent damage. (c) Copyright 2008 USA TODAY, a division of Gannett Co. Inc. <>