Adverse pregnancy outcomes and future maternal cardiovascular disease

Abstract

Cardiovascular disease (CVD) remains the leading cause of death in women. Although traditional risk factors increase later-life CVD, pregnancy-associated complications additionally influence future CVD risk in women. Recent guidelines for the prevention of CVD in women have added adverse pregnancy outcomes as major CVD risk factors. Studies have shown that women with a history of preeclampsia, gestational diabetes, preterm delivery, and delivery of a small-for-gestational-age infant have an increased risk of developing cardiometabolic risk factors and subsequent CVD. A history of multiple adverse pregnancy outcomes further increases this risk. It has been suggested that these pregnancy complications may unmask preexisting elevated CVD risk; however, whether the pathophysiologic changes underlying these conditions directly result in long-term cardiovascular damage is unclear. The purpose of this review was to highlight the associations between adverse pregnancy outcomes and future CVD, and to emphasize the importance of considering pregnancy history in assessing a woman's CVD risk. Targeted efforts to initiate screening and risk-reduction strategies in women with prior history of pregnancy complications, particularly lifestyle modification, may help decrease the burden of CVD in women.

Cardiovascular risk profile at the age of 40–45 in women with previous hyperemesis gravidarum or hypertensive disorders in pregnancy: A population-based study

“…One of the theories relates to the pathophysiology of hypertensive disorders in pregnancy, which is complex. The pathologic vascular lesion of the placenta found in preeclampsia, termed acute atherosis, is similar to that observed in atherosclerosis(125). Furthermore, poor placentation leads to release of inflammatory and antiangiogenic factors.This can cause endothelial dysfunction and impaired hemodynamics in the mother, which can persist up to several years postpartum(134).Because of this possible relationship between hyperemesis, hypertensive disorders in pregnancy, placentation and later CVD risk, this thesis investigated midlife cardiovascular risk factors in both women with hyperemesis andwomen with hypertensive disorders in pregnancy.5.3.3 HypertensionIn Paper II slightly lower mean systolic blood pressure was reported in women with a history of hyperemesis compared to the reference group (women with pregnancies without hyperemesis or hypertensive disorders).…”

Gestational diabetes and the risk of cardiovascular disease in women: a systematic review and meta-analysis

“…McKenzie-Sampson et al [20] Savitz et al [17] Tobias et al [6] Fadl et al [16] Retnakaran [21,22]. In recent years, there has been growing recognition that adverse pregnancy outcomes (such as GDM, pre-eclampsia and pre-term delivery) can identify future cardiovascular risk in women, although clinical uptake of this concept has been limited [22]. In the case of GDM, three factors have likely contributed to this limited awareness:…”

Pregnancy Complication History in 10-Year Cardiovascular Disease Risk Prediction: a Review of Recent Evidence

“…Women with pregnancy complications are also at higher risk of future cardiovascular disease (CVD), including myocardial infarction and stroke. In particular, women with history of hypertensive disorders of pregnancy (preeclampsia and gestational hypertension), preterm birth, or small for gestational age (SGA) offspring appear to have approximately twice the risk of future CVD compared to unaffected women [1][2][3]. A proportion of this risk is likely attributable to the suboptimal pre-pregnancy risk profile in women subsequently affected by pregnancy complications [4] but the risk of CVD in affected women cannot solely be explained by hereditary preponderance for CVD or worse cardiometabolic status [5,6].…”