Oral Presentation Society of Obstetric Medicine of Australia and New Zealand ASM 2026

Prevalence and Persistence of Albuminuria Up to 18 Months Postpartum Following Hypertensive Disorders of Pregnancy: A Retrospective Cohort Study (142085)

Su Jen Chua 1 2 , Emily Aldridge 3 4 5 , Kevan R Polkinghorne 6 7 8 , Maleesa Pathirana 3 4 5 , Richard Hiscock 1 2 , Gustaaf Dekker 3 4 9 , Susan Sierp 5 , Claire Roberts 10 , Margaret A Arstall 4 5 , Stephen Tong 1 2 , Anthea Lindquist 1 2
  1. Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia
  2. Mercy Perinatal, Heidelberg West, VICTORIA, Australia
  3. Robinson Research Institute, Adelaide University, Adelaide, South Australia, Australia
  4. College of Health, Adelaide University, Adelaide, South Australia, Australia
  5. Department of Cardiology, Lyell McEwin Hospital, Adelaide, South Australia, Australia
  6. Department of Nephrology, Monash Health, Clayton, Victoria, Australia
  7. School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  8. Department of Medicine, Monash University, Clayton, Victoria, Australia
  9. Department of Obstetrics and Gynaecology, Lyell McEwin Hospital, Adelaide, South Australia, Australia
  10. Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia

Background: Hypertensive disorders of pregnancy (HDP) are associated with a significant increase in the lifetime risk of cardiovascular and chronic kidney disease. Albuminuria is an early biomarker of this risk, but longitudinal postpartum data are sparse. We quantified albuminuria prevalence and persistence up to 18 months postpartum following HDP.

Materials and Methods: This retrospective cohort study (2018–2026) evaluated women with high-risk pregnancies at 6 and 18 months postpartum. The primary outcome was the incidence of an elevated urinary albumin-to-creatinine ratio (uACR). Mixed-effects regression and generalized estimating equations were utilised to adjust for confounders.

Results: In 694 women (mean age 32.1 years), those with HDP(n=317) had higher mean uACR (1.63mg/mmol [95% CI 1.37–1.89] vs. 1.08 mg/mmol [95% CI 0.91–1.24]) at 6 months postpartum and a more than twofold increase in the odds of albuminuria 3mg/mmol (Odds ratio 2.12, 95% CI: 1.21 to 3.72, p = 0.009) compared to the non-HDP group (n=377). Risk of albuminuria was highest in women with concomitant HDP and diabetes (adjusted ln coefficient 1.14, p = 0.017). By the 18-month follow-up (n=340), geometric mean UACR in the HDP cohort declined to 1.07 mg/mmol (95% CI: 0.86 to 1.29)(similar to those without HDP), but 11% of the HDP cohort still had clinically significant albuminuria (3mg/mmol).

Conclusion: HDP is associated with adverse renal effects lasting 6–18 months postpartum. While albuminuria improves for most, a high-risk subgroup, particularly those with concomitant diabetes, exhibits persistent proteinuria. Structured surveillance and intervention are necessary to mitigate long-term cardiorenal morbidity.