Cardiovascular Disease Risk Factors After Early-Onset Preeclampsia, Late-Onset Preeclampsia, and Pregnancy-Induced Hypertension

Abstract

C ardiovascular disease (CVD) has gained interest in obstetrics in recent years because large observational studies revealed a remarkable increase in the long-term risk of CVD in women who experienced different types of gestational hypertensive disorders.1-3 These include pregnancy-induced hypertension (PIH) and preeclampsia, which affect 2% to 7% of all pregnancies worldwide. 4A review by Bellamy et al 1 showed an increase of the postpartum risk of CVD events according to the severity of the hypertensive pregnancy disorder, with the highest risk in women who experienced early-onset preeclampsia. Women with a normal pregnancy have an advantage according to these results, but still develop CVD later in life. Currently, it is not possible to identify individual women who have the highest risk in developing CVD. In recent years, other studies did reveal that common modifiable risk factors such as fasting blood glucose and lipid levels are significantly elevated 6 months after a pregnancy complicated by early-onset preeclampsia .5-8 The dose-response relationship with the severity of a hypertensive pregnancy disorder and future CVD suggest that the differences in long-term CVD risk between women with a history of a hypertensive pregnancy may be dependent on variation in the underlying maternal CVD risk profiles. However, studies that compare cardiovascular risk factors between women with a previous pregnancy complicated by early-onset preeclampsia, late-onset preeclampsia, or PIH within the same population are lacking.In this study, we compare CVD risk profiles ≥3 months postpartum between women with previous early-onset preeclampsia, term preeclampsia and term gestational hypertension. We hypothesize that there is a difference in the prevalence of modifiable CVD risk factors postpartum between women with a history of a hypertensive disorder of pregnancy. Identification of women at high risk of CVD at a relatively young age may provide an opportunity for early personalized follow-up and prevention.Abstract-Observational studies have shown an increased lifetime risk of cardiovascular disease (CVD) in women who experienced a hypertensive disorder in pregnancy. This risk is related to the severity of the pregnancy-related hypertensive disease and gestational age at onset. However, it has not been investigated whether these differences in CVD risk factors are already present at postpartum cardiovascular screening. We evaluated postpartum differences in CVD risk factors in 3 subgroups of patients with a history of hypertensive pregnancy. We compared the prevalence of common CVD risk factors postpartum among 448 women with previous early-onset preeclampsia, 76 women with previous late-onset preeclampsia, and 224 women with previous pregnancy-induced hypertension. Women with previous early-onset preeclampsia were compared with women with late-onset preeclampsia and pregnancy-induced hypertension and had significantly higher fasting blood glucose (5.29 versus 4.80 and 4.83 mmol/L), insulin (9.12 versus 6.31 and 6.7 uIU/L), ...

Preeclampsia: Updates in Pathogenesis, Definitions, and Guidelines

“…Three individual studies performed in Norway, California, and Taiwan indicated that women with preeclampsia have a #12-fold increase in risk for developing cardiovascular disease (73,82,83). Additional adverse outcomes, such as the increased risk of renal disease (84), metabolic disorders (85,86), and death (73), have also been reported. Early-onset preeclampsia conferred a higher risk of end organ damage in terms of cardiovascular, respiratory, central nervous, renal, and hepatic systems compared with late onset (87).…”

Hypertensive Disorders of Pregnancy and Future Maternal Cardiovascular Risk

“…Progression to chronic hypertension postpartum may help further elucidate whether GH and preeclampsia have distinct etiologies. Specifically, 42% of women with preeclampsia and 39% of women with GH progress to hypertension after mean follow‐up of 2.5 years compared with rates as low as 1% among women with normotensive pregnancies 20, 21…”

Determinants of future cardiovascular health in women with a history of preeclampsia

“…[22][23][24][25][26][27] An overview of studies on established and novel CVD risk factors in women with a history of preeclampsia, including anthropometric measures, circulating markers and imaging modalities, is presented in Table 2. In a recent meta-analysis by Hermes et al several traditional risk factors for CVD (glucose, insulin, triglycerides, total cholesterol, HDL-cholesterol, low-density lipoprotein (LDL) cholesterol and homocysteine levels) were confirmed to be associated with previous preeclampsia in comparison to same-age women with a history of an uncomplicated pregnancy.…”