Preeclampsia and Hypertensive Disease in Pregnancy: Their Contributions to Cardiovascular Risk

Abstract

More women than men die each year of cardiovascular disease, which remains the leading cause of death in the United States. Sex-specific factors, including pregnancy-related disorders, should be considered when assessing cardiovascular (CV) risk in women. Hypertensive disorders of pregnancy have been associated with CV risk later in life and may identify women in whom earlier primary prevention may reduce their risk. This article reviews the physiologic changes in blood pressure during pregnancy, current definitions of hypertensive diseases of pregnancy and preeclampsia, and postulated pathophysiologic mechanisms leading to preeclampsia that might contribute to later CV risk. Also summarized are studies providing evidence on the association between hypertensive diseases of pregnancy and future CV risk. IntroductionCardiovascular disease (CVD) continues to be the leading cause of death in the United States. More women than men die each year of heart disease. Despite efforts to improve prevention, diagnosis, and treatment of CVD over recent years that have resulted in an overall reduction of cardiovascular (CV) death rates, CVD death rates are on the rise for women age <55 years.1 This is in part due to genderrelated differences in risk factors, symptoms, and treatment. Traditional risk factors and risk-stratification tools fail to take sex-specific risk factors for women into consideration. Gestational hypertension, diabetes mellitus (DM), and preeclampsia-eclampsia may be associated with increased risk of CVD later in life. Identification of these higher-risk women would provide the opportunity for closer surveillance and preventive programs to reduce CV risk. This article reviews the physiologic changes in blood pressure (BP) during pregnancy, current definitions of hypertensive disease of pregnancy and preeclampsia, postulated pathophysiologic mechanisms leading to preeclampsia that might contribute to later CV risk, and the evidence on the association between hypertensive diseases of pregnancy and future CV risk.Two meta-analyses of the literature were published in 2007. 2,3 To provide current data on the association between

Postpartum Healthcare After Gestational Diabetes and Hypertension

“…[7][8][9][10][11][12] Though less is known about the early trajectory of CVD risk after HDP, results from small cohort studies suggest hypertension may be diagnosed within 1-2 years of delivery, providing a rationale for follow-up care during the early postpartum years. 13,14 The identification of women who have had pregnancy complications presents an opportunity for early prevention; [15][16][17][18] a history of GDM, preeclampsia, and pregnancyinduced hypertension are now considered to be CVD risk factors according to the 2011 American Heart Association recommendations. 19 Though follow-up glucose testing is recommended after GDM for risk stratification, ongoing surveillance, lifestyle counseling, and in some cases medical treatment, 20 observational studies consistently show low rates of screening after delivery.…”

Effect of age, parity, and race on the incidence of pregnancy associated hypertension and eclampsia in the United States

“…PAH is a clinically important outcome measure [16][17][18][19][20][21][24][25][26]. The various clinical categories of PAH may have a similar cause and vary in severity of disease.…”

“…Gestational hypertension (diastolic blood pressure >95 mmHg) is associated with a 3-fold increase in frequency of fetal death. 3 Gestational hypertension and preeclampsia have similar risk factors and are precursors of insulin resistance and future cardiovascular disease [15,[17][18][19][20][21]. There are conflicting reports about the risk of preeclampsia in adolescents compared with young adults, in part because most studies lack information about parity or lack sufficient statistical power [1,2,9].…”

“…Insulin resistance in early pregnancy in nonoverweight primigravidas has a high predictive value for the risk of developing preeclampsia [13]. The future risk of developing the metabolic syndrome and adverse cardiovascular outcomes has been demonstrated in women with a history of preeclampsia [19][20][21]37,38].…”

“…Gestational hypertension, preeclampsia, and eclampsia have similar risk factors and are important markers for the future development of metabolic syndrome and cardiovascular diseases [15][16][17][18][19][20][21]. Therefore, PAH may be a useful clinical indicator.…”