Hypertensive disorders of pregnancy and cardiovascular disease risk
Authors
- A.C. Staff
- R. Dechend
- D.P. Jacobsen
Citation
- 119-141
Abstract
Pregnancy impacts health over decades and across generations. Epidemiological population-based studies over the last two decades show a strong association between future female cardiovascular disease and pregnancy complications. The association is especially strong for women with previous hypertensive disorders of pregnancy, in particular early-onset preeclampsia combined with a growth restricted offspring and following repeated preeclampsia. We describe hypertensive pregnancy disorders and their pathophysiology and summarize their associations to a wide range of cardiovascular diseases. We present established as well as novel hypotheses that may explain the mechanisms for these associations. Despite the knowledge of hypertensive pregnancy complications predicting premature cardiovascular disease, few women are today offered systematic cardio-preventive follow-up after such pregnancies. These women typically seek help from the health system at first clinical symptom of cardiovascular disease, by which time morbidity is significant. They will have missed preventive opportunities, as prevention of cardiovascular disease is most effective when started at preclinical stages. We and others argue that pregnancy is an underexploited sex-specific vascular stress test and an opportunity to initiate prevention of cardiovascular disease following delivery, when they are still at a young age. We present simple clinical follow-up suggestions after a hypertensive disorder of pregnancy, which could be amended according to local resources, health systems and the individual woman’s risk factors. A more proactive approach postpartum than today may have large effects on women’s cardiovascular health and quality of life, with positive effects also for her family, the health system expenses and would promote healthier societies.