Preeclampsia (PE) is associated with an increased risk of cardiovascular disease (CVD) in later life. Postpartum cardiovascular risk screening could identify patients who would benefit most from early intervention and lifestyle modification. However, there are no readily available methods to identify these high-risk women. We propose that placental lesions may be useful in this regard. Here, we determine the association between placental lesions and lifetime CVD risk assessed 6 months following PE. Placentas from 85 PE women were evaluated for histopathological lesions. At 6 months postpartum, a lifetime cardiovascular risk score was calculated. Placental lesions were compared between CVD risk groups and the association was assessed using odds ratios. Multivariable logistic regression was used to develop prediction models for CVD risk with placental pathology. Placentas from high-risk women had more severe lesions of maternal vascular malperfusion (MVM) and resulted in a 3-fold increased risk of screening as high-risk for CVD (OR 3.10 (1.20–7.92)) compared to women without these lesions. MVM lesion severity was moderately predictive of high-risk screening (AUC 0.63 (0.51, 0.75); sensitivity 71.8% (54.6, 84.4); specificity 54.7% (41.5, 67.3)). When clinical parameters were added, the model’s predictive performance improved (AUC 0.73 (0.62, 0.84); sensitivity 78.4% (65.4, 87.5); specificity 51.6% (34.8, 68.0)). The results suggest that placenta pathology may provide a unique modality to identify women for cardiovascular screening.
Preeclampsia (PE) is associated with an increased risk of cardiovascular disease (CVD) in later life. Postpartum cardiovascular risk screening could identify patients who would benefit most from lifestyle interventions. However, there are no readily available methods to identify these high-risk women. We propose that placental lesions may be useful in this regard. Here, we sought to determine the association between placental lesions and lifetime CVD risk. Placentas from 85 PE women were evaluated for histopathological lesions. At 6 months postpartum, a lifetime cardiovascular risk score was calculated. Placental lesions were compared between CVD risk groups and the association was assessed using odds ratios. Multivariable logistic regression was used to develop prediction models for CVD risk with placental pathology. Placentas from high-risk women had more severe lesions of maternal vascular malperfusion (MVM) and resulted in a 3-fold increased risk of screening high-risk for CVD (OR 3.10[1.20-7.92]) compared to women without these lesions. MVM lesion severity was moderately predictive of high-risk screening (AUC 0.63[0.51,0.75]; sensitivity 71.8%[54.6,84.4]; specificity 54.7%[41.5,67.3]. When clinical parameters were added, the model’s predictive performance improved (AUC 0.73[0.62,0.84]; sensitivity 78.4%[65.4,87.5]; specificity 51.6%[34.8,68.0]. The results suggest that placenta pathology may provide a unique modality to identify women for cardiovascular screening.
Objective: To determine the association between placental lesions and
lifetime cardiovascular disease (CVD) risk screening at 6 months
postpartum following preeclampsia (PE). Design: Observational cohort
study. Setting: Tertiary care centres in Ottawa and Kingston, Ontario,
Canada. Population: Women diagnosed with PE who received cardiovascular
screening at 6 months postpartum. Methods: Placentas from women
diagnosed with PE were evaluated for histopathological lesions according
to a standardised synoptic data collection form with blinding to
clinical outcomes apart from gestational age at delivery. At 6 months
postpartum, each participant was screened for cardiovascular risk
factors and a lifetime cardiovascular risk score was calculated. A risk
score >35% was deemed high risk for lifetime CVD. Main
Outcome Measures: The association between placental lesions and lifetime
CVD risk was assessed using odds ratios (OR, 95% confidence intervals).
Results: Of the 85 participants, 53 (62.4%) screened high-risk for
lifetime CVD. High-risk women had more severe lesions of maternal
vascular malperfusion (MVM). MVM lesions with a severity score
>2 resulted in a 3-fold increased risk of screening high
risk for lifetime CVD (OR 3.10 [1.20-7.92]). MVM lesion score
>2 was moderately predictive of high-risk screening (AUC
0.63 [0.51,0.75]; sensitivity: 71.8% [54.6,84.4]; specificity:
54.7% [41.5,67.3]). When clinical data was added, the model’s
predictive performance improved (AUC 0.73 [0.62,0.84] sensitivity
78.4% [65.4,87.5]; specificity 51.6% [34.8,68.0]).
Conclusions: PE women with MVM are more likely to screen high-risk for
lifetime CVD compared to women without these lesions. Placenta pathology
may provide a unique modality to identify women for postpartum
cardiovascular screening.
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