Hypertensive disorders of pregnancy and later cardiovascular disease risk in mothers and children

Abstract

Preeclampsia (PE) and gestational hypertension (GH) are pregnancy-specific diseases that occur in around 10% of pregnancies worldwide. Increasing evidence suggests that women whose pregnancies were complicated by PE or GH, and their offspring, are at increased risk of cardiovascular disease (CVD) later in life. We hypothesised that PE and GH would associate with CVD risk factors 8–10 years after the first pregnancy in the mother and child and that differences in cardiovascular risk profile would be seen between 8- and 10-year-old male and female children. This is a follow-up study of the Adelaide SCOPE pregnancy cohort where 1164 nulliparous women and their babies were recruited between 2005 and 2008. Haemodynamic function was assessed using non-invasive USCOMBP+ and USCOM1A devices. Microvascular function was assessed by post-occlusive reactive hyperaemia. Of the 273 mother–child pairs followed up, 38 women had PE and 20 had GH during pregnancy. Augmentation index (Aix) and suprasystolic pulse pressure (ssPP) were increased, whereas measures of microvascular function were decreased in children who were born to PE compared to uncomplicated pregnancies. Female children had decreased Aix and ssPP compared to male children after in utero exposure to PE. Women who developed GH during their first pregnancy had increased systolic, diastolic and mean arterial pressures compared to women who had uncomplicated pregnancy. Our data suggest that GH is associated with increased cardiovascular risk in women 8–10 years after first pregnancy and PE is associated with increased offspring risk at 8–10 years of age, highlighting differences between these two hypertensive disorders of pregnancy.

Preeclampsia and Cardiovascular Risk for Offspring

“…The impairment of microvascular function occurs long before the onset of clinical symptoms [ 58 ]. This function may be assessed using the two parameters of peak perfusion: time to max (TM), and recovery time (time to half, TH2) using laser Doppler perfusion monitoring [ 59 ]. With regard to ssPP, this risk factor is associated with obesity in children.…”

“…Plummer et al focused on the hemodynamic profiles of children aged 8-10 years exposed to PE or gestational hypertension in utero [ 59 ]. Children exposed to PE had significantly increased Aix, ssPP, TM, and TH2.…”

“…Female offspring delivered by preeclamptic mothers had significantly decreased Aix and ssPP, but increased TM and TH2 when compared to male children. Males had increased vascular stiffness, whereas females were characterized by endothelial dysfunction [ 59 ].…”

“…The increased values of Aix and ssPP, as well as an impairment of microcirculation observed in children born from pregnancies with PE, are probably connected with the fact that larger vessels may be less compliant [ 59 ]. In spite of increasing TM, there was no difference in peak perfusion.…”

“…In spite of increasing TM, there was no difference in peak perfusion. According to Plummer et al this observation may suggest an impaired post-ischaemic vasodilation and delay in the endothelial independent myogenic response [ 59 ]. The authors did not observe a decrease in peak perfusion associated with the increased recovery, but did observe that endothelial function was compensating for the endothelial independent pathway and the beginnings of vascular stiffness in the bigger vessels [ 59 ].…”