Cardiovascular-kidney-metabolic outcomes in women with hypertensive disorders of pregnancy at 12 months postpartum

BACKGROUND: Hypertensive disorders of pregnancy are risk factors for later cardiovascular and chronic kidney disease. Early postpartum trajectories of blood pressure and metabolic recovery in this high-risk population are still insufficiently defined. METHODS: A prospective, single-center, observational cohort study was conducted in the Cardiovascular-Kidney-Metabolic Women's Healthcare Prevention Program (PreCareFem) at the University Hospital St. Pölten, Austria. Participants were enrolled on presentation between 1 June 2023, and 31 March 2025. Cardiovascular and metabolic surrogate parameters, including automated blood pressure measurement, anthropometric evaluation, cardiovascular, kidney and metabolic parameters, lifestyle assessment following the components of the "Life's Essential 8", and urine albumin-creatinine ratio were assessed peripartum and at 3-6 and 12 months postpartum. RESULTS: A total of 91 women with preeclampsia (PE; n = 66) and gestational hypertension (GH; n = 25) were enrolled. At 12 months postpartum, 31% met the diagnostic criteria for arterial hypertension (PE 29%, GH 36%), 18% for prediabetes and 3% for diabetes. More than half (52%) had LDL levels > 100 mg/dL and 32% had low HDL levels. Obesity was diagnosed in 24% of participants, 8% of women were diagnosed with CKD 12 months postpartum. Low-grade albuminuria (uACR 10-30 mg/g) was observed in 21% of women with PE compared to 8% in women with GH. CONCLUSION: A significant number of women were diagnosed with arterial hypertension, early kidney impairment and/or metabolic abnormalities 1 year following hypertensive disorders of pregnancy. These findings highlight the need for a structured, multidisciplinary postpartum follow-up to address an underutilized opportunity for prevention of cardiovascular and chronic kidney disease.