Hypertensive Disorders of Pregnancy and Future Cardiovascular Health

Abstract

Hypertensive disorders of pregnancy (HDP) occur in almost 10% of gestations. These women are known to have higher cardiovascular morbidity and mortality later in life in comparison with parous controls who had normotensive pregnancies. Several studies have demonstrated that women with preeclampsia present in a state of segmental impaired myocardial function, biventricular chamber dysfunction, adverse biventricular remodeling, and hypertrophy, a compromised hemodynamic state and indirect echocardiographic signs of localized myocardial ischemia and fibrosis. These cardiac functional and geometric changes are known to have strong predictive value for cardiovascular disease in non-pregnant subjects. A "dose effect" response seems to regulate this relationship with severe HDP, early-onset HDP, coexistence of fetal growth disorders, and recurrence of HDP resulting in poorer cardiovascular measures. The mechanism underlying the relationship between HDP in younger women and cardiovascular disease later in life is unclear but could be explained by sharing of pre-pregnancy cardiovascular risk factors or due to a direct impact of HDP on the maternal cardiovascular system conferring a state of increased susceptibility to future metabolic or hemodynamic insults. If so, the prevention of HDP itself would become all the more urgent. Shortly after delivery, women who experienced HDP express an increased risk of classic cardiovascular risk factors such as essential hypertension, renal disease, abnormal lipid profile, and diabetes with higher frequency than controls. Within one or two decades after delivery, this group of women are more likely to experience premature cardiovascular events, such as symptomatic heart failure, myocardial ischemia, and cerebral vascular disease. Although there is general agreement that women who suffered from HDP should undertake early screening for cardiovascular risk factors in order to allow for appropriate prevention, the exact timing and modality of screening has not been standardized yet. Our findings suggest that prevention should start as early as possible after delivery by making the women aware of their increased cardiovascular risk and encouraging weight control, stop smoking, healthy diet, and daily exercise which are well-established and cost-effective prevention strategies.

Scrub Typhus Leading to Acute Liver Failure in a Pregnant Patient

“…Non-infectious causes worthy of consideration in this case were pre-eclampsia, eclampsia and acute fatty liver of pregnancy. Her normal antenatal blood pressure records, absence of proteinuria, and acute presentation made hypertensive disorders implausible [18]. Acute fatty liver of pregnancy presents with non-specific signs and symptoms, such as nausea, vomiting, fatigue and anorexia, leading eventually to liver failure.…”

Working Agenda for Black Mothers

“…To this point, it is hypothesized to cause some of these APOs, such as preeclampsia, preeclampsia with severe features, eclampsia, or preeclampsia superimposed on chronic hypertension. 25 The American Heart Association has already recognized these conditions as independent risk factors for CVD and introduced these complications of pregnancy in the algorithms for the evaluation of future cardiovascular risk scores. 26 These are classified as hypertensive disorders of pregnancy, in addition to gestational hypertension, defined as new-onset hypertension after 20 weeks of gestation, or chronic hypertension.…”

Awareness of obstetricians for long-term risks in women with a history of preeclampsia or HELLP syndrome

“…It has also been shown that women with a history of PE have an up to five-to 12-fold increased risk of developing end-stage renal disease later in life [11,13]. The association between PE and future CVD is no surprise given the fact that several studies have revealed that women with PE are in a state of cardiac dysfunction [5,14]. PE has been shown to be associated with cardiovascular changes such as a decrease in cardiac output, increased systemic vascular resistance and left ventricular diastolic dysfunction [5,6,14,15].…”