Screening for primary hyperaldosteronism, pregnancy

On a global scale, 5%–10% of pregnancies are complicated by hypertensive disorders of pregnancy (HDP), which can lead to serious maternal, fetal, and neonatal complications. Many of these women have pre-existing hypertension (<20 weeks of pregnancy) or hypertension postpartum that persists for more than 3 months. It has also been shown that women with a self-managed postpartum HDP are at high risk of developing chronic hypertension and cardiovascular complications later.

Excessive production of aldosterone, a hormone secreted by the adrenal gland, leads to sodium retention in the kidneys and excessive excretion of potassium in the urine. The prevalence of primary hyperaldosteronism (PH) in hypertensive patients is close to 10%–20% in people with severe hypertension. Among its main causes are unilateral adrenal adenomas secreting aldosterone autonomously or bilateral adrenal hyperplasia. Over 88% of adenomas are now associated with genetic mutations (Namba K, 2018).

Treatment is mainly surgical for adenomas, or medical for hyperplasia. The fact that primary hyperaldosteronism is associated with an increased prevalence of cardiovascular complications compared with essential hypertension makes it is all the more important to diagnose early. Early detection and treatment that limits long-term cardiovascular health consequences is therefore vital for young mothers with chronic hypertension. In addition, pregnancy outcomes appear to be better when PH is diagnosed and treated before pregnancy. The main objective of this study is to determine whether the prevalence of PH is sufficient (>5%) to recommend routine screening in all women who have had a HDP, or only in certain women. Secondary objectives are to differentiate the maternal and fetal complications between women with PH and those without.