Pregnancy Complications as a Window to Future Cardiovascular Disease

Abstract

Pregnancy is a time of significant hemodynamic, metabolic, and hormonal stress that can unmask underlying subclinical cardiovascular abnormalities, and pregnancy-related complications may serve as early warning signs for future risk of cardiovascular disease. The increased recognition of these sex-specific risk factors could identify women who may benefit from more intensive risk factor modification to reduce morbidity and mortality later in life. In this review, we describe several pregnancy-related complications that have been associated with the risk of cardiovascular disease, including hypertensive disorders of pregnancy, gestational diabetes mellitus, preterm delivery, and pregnancy loss. Pregnancy-associated risk factors must be identified to fully assess a woman’s future cardiovascular risk and may influence strategies for risk reduction.

Does Adding Adverse Pregnancy Outcomes Improve the Framingham Cardiovascular Risk Score in Women? Data from the Tehran Lipid and Glucose Study

“…Pregnancy complications are red flags for CVDs, 51 and extensive evidence has highlighted the pregnancy‐related cardiovascular risk factors. 5 , 9 , 52 Approximately 10% to 20% of pregnancies are complicated by APOs. 53 These common factors are underlying but often neglected cardiovascular risk indicators.…”

“… 5 , 8 APOs, such as gestational diabetes (GD), hypertensive disorders of pregnancy, preterm delivery (PTD), pregnancy loss, placental abruption, and stillbirth, act as a window for initiation of pathophysiological changes, which lead to cardiometabolic abnormalities in the later life of women. 9 , 10 Moreover, APOs might be reflecting predisposition factors (including hormonal changes, dyslipidemia, chronic hypertension, and metabolic syndrome) for developing CVDs in the future. 11 , 12 , 13 Another possible explanation may emerge from abnormal metabolic conditions in complicated pregnancies, which might have been continued after delivery and led to metabolic and vascular damages in the long term.…”

Effect of Gestational Weight Gain during the First Half of Pregnancy on the Incidence of GDM, Results from a Pregnant Cohort in Northern Greece

“…GDM imposes a medical alert for both the mother and the fetus as it is highly associated with adverse obstetric and perinatal outcomes [ 5 ]. Maternal outcomes include proximate complications, such as cesarean delivery, and future metabolic disorders, such as metabolic syndrome and type 2 diabetes mellitus [ 6 , 7 , 8 , 9 ]. Fetal complications that are related to GDM include fetal overgrowth leading to large for gestational age (LGA) neonates, respiratory distress syndrome (RDS), preterm birth, and stillbirth [ 10 , 11 ]; there are also looming future risks for obesity, cardiovascular disease, glucose intolerance, and learning difficulties [ 12 , 13 , 14 ].…”

Pre-Pregnancy Adherence to Mediterranean Diet and Risk of Gestational Diabetes Mellitus: A Prospective Cohort Study in Greece

“…Pregnancies with GDM are considered high-risk, as they are associated with a series of adverse outcomes, such as caesarean delivery, preeclampsia, macrosomia, preterm birth, and stillbirth [ 3 ]. Moreover, the pathophysiologic dysregulation that occurs in GDM may also have an impact in later life for both the mother and the offspring; it is a crucial determinant of healthcare cost and influences the quality of life of those affected [ 4 , 5 , 6 , 7 , 8 ]. Additionally, due to the absence of unanimous consensus among guidelines on the diagnosis and management of GDM, a number of cases may escape the appropriate attention.…”