Long-term consequences of previous preeclampsia and complicated pregnancy: analysis of echocardiographic aspects

Abstract

Aim To evaluated echocardiographic aspects in women with history of preeclampsia or preeclampsia-related complications in their previous pregnancies. Materials and methods Consecutive women receiving echocardiography during daily clinical echolab activity were studied using complete echocardiographic examination data and anamnestic data collection of hypertension, diabetes, dyslipidemia, and rheumatic diseases. Studied women should have at least one pregnancy in more than the 10 past years, and were subdivided into two groups according to the history of complicated or physiological pregnancy. Complicated pregnancies were defined by preeclampsia or preeclampsia-related complication, such as preterm delivery or small-for-gestational age newborn. Echocardiographic parameters and prevalence of hypertension, diabetes, dyslipidemia, and rheumatic disease were compared between the two groups of studied women. Results From March 2016 to May 2020, 545 women were studied, of whom 218 had a history of complicated pregnancy (mean age 60.81 ± 11.109 years vs. 62.78 ± 9.758 years of not complicated pregnancy; P = 0.03). Compared with physiological pregnancy women, complicated pregnancy ones were shorter (159.97 ± 6.608 vs. 161.42 ± 6.427 cm; P = 0.012) with lower body surface area (1.678 ± 0.1937 vs. 1.715 ± 0.1662 m2; P = 0.02), had higher prevalence of diabetes (6.9 vs. 3.1%; P = 0.04; odds ratio = 2.34; CI 1.0323--5.3148) and rheumatic diseases (33 vs. 22.3%; P = 0.006; odds ratio = 1.72; CI 1.1688--2.5191), and showed a slight, not significant higher prevalence of hypertension. As for echocardiographic parameters, they showed significantly higher values of end-diastolic left ventricular posterior wall (LPWd) (P = 0.034), a trend toward a more concentric geometry, and a worse longitudinal systolic left and right ventricle performance, represented by lower tissue Doppler systolic waves (septal: 7.41 ± 1.255 vs. 7.69 ± 1.376 cm/s; P = 0.018; and tricuspidalic: 12.64 ± 2.377 vs. 13.32 ± 2.548 cm/s; P = 0.003). Conclusion Patients with previous preeclampsia present an increased risk of hypertension, diabetes, and rheumatic diseases, suggesting that these women could share a specific predisposition to a high-risk profile. Furthermore, they show a higher prevalence of classically considered echocardiographic hypertensive-derived cardiac damage, suggesting structural and functional left ventricular modifications as subclinical aspects of long-term worse cardiovascular prognosis for these women.

Revealing the impact of lifestyle stressors on the risk of adverse pregnancy outcomes with multitask machine learning

“…Supplementary Figures S1, S2, and Supplementary Table S1 describe the demographics of the pregnant women, the distribution of BMI, and GA at delivery. Figure 2 represents the interconnectedness of APOs and RFs in our dataset based on Spearman correlation, confirming known relationships between APORFs established in prior studies ( 26 , 34 – 37 ). There are biological underpinnings to these correlations; for instance, prior studies found that TGF-β is a common biological factor between preeclampsia and diabetes ( 38 , 39 ).…”

“…Although APOs are comparably rare, and thus challenging to model, their biological relationship and frequent presence as comorbidities provide an avenue for joint modeling approaches like MML to increase predictive power. As mentioned in the introduction, hypertension during pregnancy is correlated with diabetes and BMI; gestational diabetes is connected to hypertensive disorders, preeclampsia, and PTB; and prior preeclampsia is tied to an increased risk of hypertension and diabetes ( 26 , 27 , 34 ). As shown by our results, MML successfully models APOs simultaneously, outperforming single task approaches.…”

Cardiovascular risk stratification in young women: the pivotal role of pregnancy

“…46 The exact mechanisms linking preeclampsia to heart failure risk are still being studied, but it is believed that the cardiovascular changes during pregnancy may have long-term effects on heart health. 47,48 A common pathophysiological pathway has been identified linking preeclampsia and fetal growth retardation (FGR) to the development of heart failure with preserved ejection fraction (HFpEF) later in life. This pathway involves several interconnected mechanisms, including chronic inflammation, oxidative stress, vascular biological aging, and myocardial subclinical involvement.…”

Hypertensive Disorders of Pregnancy and the Cardiovascular System: Causes, Consequences, Therapy, and Prevention

“…These changes are accentuated in women with concurrent gestational hypertensive disorders. Among asymptomatic women delivered for preterm preeclampsia, over half have echocardiographic evidence of moderate to severe left ventricular dysfunction or hypertrophy and one year after delivery 99,100 . These cardiac changes are likely precipitated by increased arterial stiffness, increased peripheral resistance, and resultant increased cardiac output that are both characteristic of preeclampsia and…”

“…Among asymptomatic women delivered for preterm preeclampsia, over half have echocardiographic evidence of moderate to severe left ventricular dysfunction or hypertrophy 1 year after delivery. 103,104 These cardiac changes are likely precipitated by increased arterial stiffness, increased peripheral resistance, and resultant increased cardiac output that are both characteristic of preeclampsia and proportional to the duration and severity of the condition. 103,[105][106][107][108] One year after delivery, women with history of preeclampsia have higher SBP and DBP, higher insulin levels, higher elevated total and low-density lipoprotein cholesterol levels and detectable microalbuminuria.…”