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Preeclampsia pp 273-290 | Cite as

Cardiovascular Disease Following Hypertensive Pregnancy

  • Franziska Pettit
  • George Mangos
  • Mark A. BrownEmail author
Chapter
Part of the Comprehensive Gynecology and Obstetrics book series (CGO)

Abstract

Cardiovascular disease, including ischaemic heart disease and cerebrovascular disease, has become the number one cause of death in women worldwide. Having had a pregnancy complicated by pre-eclampsia may be more than just a risk factor for the development of cardiovascular disease later in life. Pre-eclampsia causes significant morbidity and mortality in the acute setting with multisystem involvement. We are now learning that while these acute effects resolve in the short to medium term, their legacy is long-lasting. In this chapter we explore the mechanisms involved in the development of long-term hypertension, chronic kidney disease, ischaemic heart and cerebrovascular disease, diabetes and venous thromboembolism. Ways in which the post-partum period can be used to improve the long-term health of these women are reviewed, including the difficulties in identifying subtle abnormalities in parameters such as post-partum blood pressure because normal values have been based on studies often done on middle-aged men. Unfortunately diet and exercise on their own appear to be ineffective in reducing the risk but are important first steps for new mothers to alter their longer-term risks and improve their journey through subsequent pregnancies.

Keywords

Pre-eclampsia Ischemic heart disease Stroke Hypertension Metabolic syndrome 

References

  1. 1.
    Mosca L, Benjamin EJ, Berra K, Bezanson JL, Dolor RJ, Lloyd-Jones DM, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women—2011 update: a guideline from the American Heart Association. Circulation. 2011;123(11):1243–62.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Lloyd-Jones DM, Tian L. Predicting cardiovascular risk: so what do we do now? Arch Intern Med. 2006;166(13):1342–4.CrossRefPubMedGoogle Scholar
  3. 3.
    Berks D, Hoedjes M, Raat H, Duvekot JJ, Steegers EA, Habbema JD. Risk of cardiovascular disease after pre-eclampsia and the effect of lifestyle interventions: a literature-based study. BJOG. 2013;120(8):924–31.CrossRefPubMedGoogle Scholar
  4. 4.
    Qureshi AI, Saeed O, Malik AA, Suri MFK. Pregnancy in advanced age and the risk of stroke in postmenopausal women: analysis of Womens Health Initiative Study. Am J Obstet Gynecol. 2017;216(4):409.e1–6.CrossRefGoogle Scholar
  5. 5.
    Chesley LC. Remote prognosis after eclampsia. Perspect Nephrol Hypertens. 1976;5:31–40.PubMedGoogle Scholar
  6. 6.
    Catov JM, Newman AB, Sutton-Tyrrell K, Harris TB, Tylavsky F, Visser M, et al. Parity and cardiovascular disease risk among older women: how do pregnancy complications mediate the association? Ann Epidemiol. 2008;18(12):873–9.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Williams D. Pregnancy: a stress test for life. Curr Opin Obstet Gynecol. 2003;15(6):465–71.CrossRefPubMedGoogle Scholar
  8. 8.
    MacGillivray I. Pre-eclampsia: the hypertensive disease of pregnancy. London: WB Saunders; 1983.Google Scholar
  9. 9.
    Chesley LC. Hypertensive disorders in pregnancy. New York: Appleton-Century-Crofts; 1978.Google Scholar
  10. 10.
    Brown MA. Pre-eclampsia: a life-long disorder. Med J Aust. 2003;179:182–4.PubMedGoogle Scholar
  11. 11.
    Brown MA. Pre-eclampsia in 2014: seven ways to make a difference. Pregnancy Hypertens. 2014;4(4):249–52.CrossRefPubMedGoogle Scholar
  12. 12.
    Bryans CI Jr. The remote prognosis in toxemia of pregnancy. Clin Obstet Gynecol. 1966;9(4):973–90.CrossRefPubMedGoogle Scholar
  13. 13.
    Fisher KA, Luger A, Spargo BH, Lindheimer MD. Hypertension in pregnancy: clinical-pathological correlations and remote prognosis. Medicine (Baltimore). 1981;60(4):267–76.CrossRefGoogle Scholar
  14. 14.
    Sibai BM, el-Nazer A, Gonzalez-Ruiz A. Severe preeclampsia-eclampsia in young primigravid women: subsequent pregnancy outcome and remote prognosis. Am J Obstet Gynecol. 1986;155(5):1011–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Mangos GJ, Spaan JJ, Pirabhahar S, Brown MA. Markers of cardiovascular disease risk after hypertension in pregnancy. J Hypertens. 2012;30(2):351–8.  https://doi.org/10.1097/HJH.0b013e32834e5ac7. CrossRefPubMedGoogle Scholar
  16. 16.
    Irgens HU, Roberts JM, Reisæter L, Irgens LM, Lie RT. Long term mortality of mothers and fathers after pre-eclampsia: population based cohort study. BMJ. 2001;323(7323):1213–7.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Wilson BJ, Watson MS, Prescott GJ, Sunderland S, Campbell DM, Hannaford P, et al. Hypertensive diseases of pregnancy and risk of hypertension and stroke in later life: results from cohort study. BMJ. 2003;326(7394):845.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Bellamy L, Casas JP, Hingorani AD, Williams DJ. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ. 2007;335(7627):974.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Thorogood M, Mann J, Murphy M, Vessey M. Fatal stroke and use of oral contraceptives: findings from a case-control study. Am J Epidemiol. 1992;136(1):35–45.CrossRefPubMedGoogle Scholar
  20. 20.
    Jonsdottir LS, Arngrimsson R, Geirsson RT, Sigvaldason H, Sigfusson N. Death rates from ischemic heart disease in women with a history of hypertension in pregnancy. Acta Obstet Gynecol Scand. 1995;74(10):772–6.CrossRefPubMedGoogle Scholar
  21. 21.
    McDonald SD, Malinowski A, Zhou Q, Yusuf S, Devereaux PJ. Cardiovascular sequelae of preeclampsia/eclampsia: a systematic review and meta-analyses. Am Heart J. 2008;156(5):918–30.CrossRefPubMedGoogle Scholar
  22. 22.
    Lykke JA, Paidas MJ, Langhoff-Roos J. Recurring complications in second pregnancy. Obstet Gynecol. 2009;113(6):1217–24.CrossRefPubMedGoogle Scholar
  23. 23.
    Garovic VD, Bailey KR, Boerwinkle E, Hunt SC, Weder AB, Curb D, et al. Hypertension in pregnancy as a risk factor for cardiovascular disease later in life. J Hypertens. 2010;28(4):826–33.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Hermes W, Franx A, van Pampus MG, Bloemenkamp KW, Bots ML, van der Post JA, et al. Cardiovascular risk factors in women who had hypertensive disorders late in pregnancy: a cohort study. Am J Obstet Gynecol. 2013;208(6):474.e1–8.CrossRefGoogle Scholar
  25. 25.
    Scholten RR, Lotgering FK, Hopman MT, Van Dijk A, Van de Vlugt M, Janssen MCH, et al. Low plasma volume in normotensive formerly preeclamptic women predisposes to hypertension. Hypertension. 2015;66(5):1066–72.CrossRefPubMedGoogle Scholar
  26. 26.
    Parikh NI, Norberg M, Ingelsson E, Cnattingius S, Vasan RS, Domellöf M, et al. Association of pregnancy complications and characteristics with future risk of elevated blood pressure. The Västerbotten Intervention Program. Hypertension. 2017;69(3):475–83.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Bokslag A, Teunissen PW, Franssen C, van Kesteren F, Kamp O, Ganzevoort W, et al. Effect of early-onset preeclampsia on cardiovascular risk in the fifth decade of life. Am J Obstet Gynecol. 2017;216(5):523.e1–7.CrossRefGoogle Scholar
  28. 28.
    Tooher J, Thornton C, Makris A, Ogle R, Korda A, Horvath J, et al. Hypertension in pregnancy and long-term cardiovascular mortality: a retrospective cohort study. Am J Obstet Gynecol. 2016;214(6):722.e1–6.CrossRefGoogle Scholar
  29. 29.
    Theilen LH, Fraser A, Hollingshaus MS, Schliep KC, Varner MW, Smith KR, et al. All-cause and cause-specific mortality after hypertensive disease of pregnancy. Obstet Gynecol. 2016;128(2):238–44.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Theilen L, Meeks H, Fraser A, Esplin MS, Smith KR, Varner M. Long-term mortality risk and life expectancy following recurrent hypertensive disease of pregnancy. Am J Obstet Gynecol. 2017;216(1 Suppl):S32–S3.CrossRefGoogle Scholar
  31. 31.
    Gaugler-Senden IP, Berends AL, de Groot CJ, Steegers EA. Severe, very early onset preeclampsia: subsequent pregnancies and future parental cardiovascular health. Eur J Obstet Gynecol Reprod Biol. 2008;140(2):171–7.CrossRefPubMedGoogle Scholar
  32. 32.
    Postma IR, Groen H, Easterling TR, Tsigas EZ, Wilson ML, Porcel J, et al. The brain study: cognition, quality of life and social functioning following preeclampsia; an observational study. Pregnancy Hypertens. 2013;3(4):227–34.CrossRefPubMedGoogle Scholar
  33. 33.
    Postma IR, de Groot JC, Aukes AM, Aarnoudse JG, Zeeman GG. Cerebral white matter lesions and perceived cognitive dysfunction: the role of pregnancy. Am J Obstet Gynecol. 2014;211(3):257.e1–5.CrossRefGoogle Scholar
  34. 34.
    Soma-Pillay P, Suleman FE, Makin JD, Pattinson RC. Cerebral white matter lesions after pre-eclampsia. Pregnancy Hypertens. 2017;8:15–20.CrossRefPubMedGoogle Scholar
  35. 35.
    Aukes AM, de Groot JC, Aarnoudse JG, Zeeman GG. Brain lesions several years after eclampsia. Am J Obstet Gynecol. 2009;200(5):504.e1–5.CrossRefGoogle Scholar
  36. 36.
    Strevens H, Wide-Swensson D, Hansen A, Horn T, Ingemarsson I, Larsen S, et al. Glomerular endotheliosis in normal pregnancy and pre-eclampsia. BJOG. 2003;110(9):831–6.CrossRefPubMedGoogle Scholar
  37. 37.
    Sibai BM, Villar MA, Mabie BC. Acute renal failure in hypertensive disorders of pregnancy. Pregnancy outcome and remote prognosis in thirty-one consecutive cases. Am J Obstet Gynecol. 1990;162(3):777–83.CrossRefPubMedGoogle Scholar
  38. 38.
    Drakeley AJ, Le Roux PA, Anthony J, Penny J. Acute renal failure complicating severe preeclampsia requiring admission to an obstetric intensive care unit. Am J Obstet Gynecol. 2002;186(2):253–6.CrossRefPubMedGoogle Scholar
  39. 39.
    Lindheimer MD, Katz AI. Kidney function and disease in pregnancy. Philadelphia: Lea & Febiger; 1977.Google Scholar
  40. 40.
    Vikse BE, Irgens LM, Leivestad T, Skjaerven R, Iversen BM. Preeclampsia and the risk of end-stage renal disease. N Engl J Med. 2008;359(8):800–9.CrossRefPubMedGoogle Scholar
  41. 41.
    Wang I-K, Muo C-H, Chang Y-C, Liang J-C, Chang C-T, Lin S-Y, et al. Association between hypertensive disorders during pregnancy and end-stage renal disease: a population-based study. Can Med Assoc J. 2013;185(3):207–13.CrossRefGoogle Scholar
  42. 42.
    McDonald SD, Han Z, Walsh MW, Gerstein HC, Devereaux PJ. Kidney disease after preeclampsia: a systematic review and meta-analysis. Am J Kidney Dis. 2010;55(6):1026–39.CrossRefPubMedGoogle Scholar
  43. 43.
    Kim C, Newton KM, Knopp RH. Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care. 2002;25(10):1862–8.CrossRefPubMedGoogle Scholar
  44. 44.
    Ben-Haroush A, Yogev Y, Hod M. Epidemiology of gestational diabetes mellitus and its association with type 2 diabetes. Diabet Med. 2004;21(2):103–13.CrossRefPubMedGoogle Scholar
  45. 45.
    Lykke JA, Langhoff-Roos J, Sibai BM, Funai EF, Triche EW, Paidas MJ. Hypertensive pregnancy disorders and subsequent cardiovascular morbidity and type 2 diabetes mellitus in the mother. Hypertension. 2009;53(6):944–51.CrossRefPubMedGoogle Scholar
  46. 46.
    Callaway LK, Lawlor DA, O'Callaghan M, Williams GM, Najman JM, McIntyre HD. Diabetes mellitus in the 21 years after a pregnancy that was complicated by hypertension: findings from a prospective cohort study. Am J Obstet Gynecol. 2007;197(5):492 e1–7.CrossRefGoogle Scholar
  47. 47.
    Laivuori H, Tikkanen MJ, Ylikorkala O. Hyperinsulinemia 17 years after preeclamptic first pregnancy. J Clin Endocrinol Metab. 1996;81(8):2908–11.PubMedGoogle Scholar
  48. 48.
    Forest JC, Girouard J, Masse J, Moutquin JM, Kharfi A, Ness RB, et al. Early occurrence of metabolic syndrome after hypertension in pregnancy. Obstet Gynecol. 2005;105(6):1373–80.CrossRefPubMedGoogle Scholar
  49. 49.
    Pouta A, Hartikainen AL, Sovio U, Gissler M, Laitinen J, McCarthy MI, et al. Manifestations of metabolic syndrome after hypertensive pregnancy. Hypertension. 2004;43(4):825–31.CrossRefPubMedGoogle Scholar
  50. 50.
    Hannaford P, Ferry S, Hirsch S. Cardiovascular sequelae of toxaemia of pregnancy. Heart. 1997;77(2):154–8.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Pabinger I, Grafenhofer H, Kaider A, Ilic A, Eichinger S, Quehenberger P, et al. Preeclampsia and fetal loss in women with a history of venous thromboembolism. Arterioscler Thromb Vasc Biol. 2001;21(5):874–9.CrossRefPubMedGoogle Scholar
  52. 52.
    Jacobsen AF, Skjeldestad FE, Sandset PM. Incidence and risk patterns of venous thromboembolism in pregnancy and puerperium—a register-based case-control study. Am J Obstet Gynecol. 2008;198(2):233 e1–7.CrossRefGoogle Scholar
  53. 53.
    Alsnes IV, Vatten LJ, Fraser A, Bjørngaard JH, Rich-Edwards J, Romundstad PR, et al. Hypertension in pregnancy and offspring cardiovascular risk in young adulthood: prospective and sibling studies in the HUNT study (Nord-Trøndelag Health Study) in Norway. Hypertension. 2017;69(4):591–8.CrossRefPubMedGoogle Scholar
  54. 54.
    Bartels A, Egan N, Broadhurst DI, Khashan AS, Joyce C, Stapleton M, et al. Maternal serum cholesterol levels are elevated from the 1st trimester of pregnancy: a cross-sectional study. J Obstet Gynaecol. 2012;32(8):747–52.CrossRefPubMedGoogle Scholar
  55. 55.
    Stekkinger E, Zandstra M, Peeters LL, Spaanderman ME. Early-onset preeclampsia and the prevalence of postpartum metabolic syndrome. Obstet Gynecol. 2009;114(5):1076–84.CrossRefPubMedGoogle Scholar
  56. 56.
    Stekkinger E, Scholten RR, van der Vlugt MJ, van Dijk APJ, Janssen MCH, Spaanderman MEA. Metabolic syndrome and the risk for recurrent pre-eclampsia: a retrospective cohort study. BJOG. 2013;120(8):979–86.CrossRefPubMedGoogle Scholar
  57. 57.
    Alsnes IV, Janszky I, Forman MR, Vatten LJ, Økland I. A population-based study of associations between preeclampsia and later cardiovascular risk factors. Am J Obstet Gynecol. 2014;211(6):657.e1–7.CrossRefGoogle Scholar
  58. 58.
    Schobel HP, Fischer T, Heuszer K, Geiger H, Schmieder RE. Preeclampsia—a state of sympathetic overactivity. N Engl J Med. 1996;335(20):1480–5.CrossRefPubMedGoogle Scholar
  59. 59.
    Brown MA. Pre-eclampsia: a case of nerves? Lancet. 1997;349(9048):297–8.CrossRefPubMedGoogle Scholar
  60. 60.
    Collén A-C, Manhem K, Sverrisdóttir YB. Sympathetic nerve activity in women 40 years after a hypertensive pregnancy. J Hypertens. 2012;30(6):1203–10.  https://doi.org/10.1097/HJH.0b013e3283531ed2.CrossRefPubMedGoogle Scholar
  61. 61.
    Melchiorre K, Sharma R, Khalil A, Thilaganathan B. Maternal cardiovascular function in normal pregnancy: evidence of maladaptation to chronic volume overload. Hypertension. 2016;67(4):754–62.CrossRefPubMedGoogle Scholar
  62. 62.
    Melchiorre K, Sharma R, Thilaganathan B. Cardiovascular implications in preeclampsia. Circulation. 2014;130(8):703–14.CrossRefPubMedGoogle Scholar
  63. 63.
    Melchiorre K, Sutherland GR, Liberati M, Thilaganathan B. Preeclampsia is associated with persistent postpartum cardiovascular impairment. Hypertension. 2011;58(4):709–15.CrossRefPubMedGoogle Scholar
  64. 64.
    Ghossein-Doha C, Peeters L, van Heijster S, van Kuijk S, Spaan J, Delhaas T, et al. Hypertension after preeclampsia is preceded by changes in cardiac structure and function. Hypertension. 2013;62(2):382–90.CrossRefPubMedGoogle Scholar
  65. 65.
    Valensise H, Lo Presti D, Gagliardi G, Tiralongo GM, Pisani I, Novelli GP, et al. Persistent maternal cardiac dysfunction after preeclampsia identifies patients at risk for recurrent preeclampsia. Hypertension. 2016;67(4):748–53.CrossRefPubMedGoogle Scholar
  66. 66.
    Brown MA, Gallery EDM. Volume homeostasis in normal pregnancy and pre-eclampsia: physiology and clinical implications. Baillieres Clin Obstet Gynaecol. 1994;8(2):287–310.CrossRefPubMedGoogle Scholar
  67. 67.
    Magness RR, Shaw CE, Phernetton TM, Zheng J, Bird IM. Endothelial vasodilator production by uterine and systemic arteries. II. Pregnancy effects on NO synthase expression. Am J Physiol. 1997;272(4 Pt 2):H1730–40.PubMedGoogle Scholar
  68. 68.
    Irani RA, Xia Y. The functional role of the renin-angiotensin system in pregnancy and preeclampsia. Placenta. 2008;29(9):763–71.CrossRefPubMedPubMedCentralGoogle Scholar
  69. 69.
    White WM, Mielke MM, Araoz PA, Lahr BD, Bailey KR, Jayachandran M, et al. A history of preeclampsia is associated with a risk for coronary artery calcification 3 decades later. Am J Obstet Gynecol. 2016;214(4):519.e1–8.CrossRefGoogle Scholar
  70. 70.
    Visser S, Hermes W, Ket JCF, Otten RHJ, van Pampus MG, Bloemenkamp KWM, et al. Systematic review and metaanalysis on nonclassic cardiovascular biomarkers after hypertensive pregnancy disorders. Am J Obstet Gynecol. 2014;211(4):373.e1–9.CrossRefGoogle Scholar
  71. 71.
    Scholten RR, Thijssen DJH, Lotgering FK, Hopman MTE, Spaanderman MEA. Cardiovascular effects of aerobic exercise training in formerly preeclamptic women and healthy parous control subjects. Am J Obstet Gynecol. 2014;211(5):516.e1–e11.CrossRefGoogle Scholar
  72. 72.
    Sandvik MK, Leirgul E, Nygård O, Ueland PM, Berg A, Svarstad E, et al. Preeclampsia in healthy women and endothelial dysfunction 10 years later. Am J Obstet Gynecol. 2013;209(6):569.e1–e10.CrossRefGoogle Scholar
  73. 73.
    Rich-Edwards JW, Fraser A, Lawlor DA, Catov JM. Pregnancy characteristics and women's future cardiovascular health: an underused opportunity to improve women's health? Epidemiol Rev. 2014;36:57–70.CrossRefPubMedGoogle Scholar
  74. 74.
    Spaan J, Peeters L, Spaanderman M, Brown M. Cardiovascular risk management after a hypertensive disorder of pregnancy. Hypertension. 2012;60(6):1368–73.CrossRefPubMedGoogle Scholar
  75. 75.
    Schmittdiel J, Selby JV, Swain B, Daugherty SL, Leong TK, Ho M, et al. Missed opportunities in cardiovascular disease prevention? Low rates of hypertension recognition for women at medicine and obstetrics-gynecology clinics. Hypertension. 2011;57(4):717–22.CrossRefPubMedPubMedCentralGoogle Scholar
  76. 76.
    Hermes W, Tamsma JT, Grootendorst DC, Franx A, van der Post J, van Pampus MG, et al. Cardiovascular risk estimation in women with a history of hypertensive pregnancy disorders at term: a longitudinal follow-up study. BMC Pregnancy Childbirth. 2013;13:126.CrossRefPubMedPubMedCentralGoogle Scholar
  77. 77.
    Breetveld NM, Ghossein-Doha C, van Kuijk SMJ, van Dijk AP, van der Vlugt MJ, Heidema WM, et al. Cardiovascular disease risk is only elevated in hypertensive, formerly preeclamptic women. BJOG. 2015;122(8):1092–100.CrossRefPubMedGoogle Scholar
  78. 78.
    van Baaren G-J, Hermes W, Franx A, van Pampus MG, Bloemenkamp KWM, van der Post JA, et al. Cost-effectiveness analysis of cardiovascular risk factor screening in women who experienced hypertensive pregnancy disorders at term. Pregnancy Hypertens. 2014;4(4):264–70.CrossRefPubMedGoogle Scholar
  79. 79.
    Davis GK, Roberts L, Mangos G, Henry A, Pettit F, O’Sullivan A, et al. Postpartum physiology, psychology and paediatric follow up study (P4 study)—study protocol. Pregnancy Hypertens. 2016.Google Scholar
  80. 80.
    Raw M, McNeill A, West R. Smoking cessation: evidence based recommendations for the healthcare system. BMJ. 1999;318(7177):182–5.CrossRefPubMedPubMedCentralGoogle Scholar
  81. 81.
    Estruch R, Ros E, Martinez-Gonzalez MA. Mediterranean diet for primary prevention of cardiovascular disease. N Engl J Med. 2013;369(7):676–7.PubMedGoogle Scholar
  82. 82.
    Barakat R, Pelaez M, Cordero Y, Perales M, Lopez C, Coteron J, et al. Exercise during pregnancy protects against hypertension and macrosomia: randomized clinical trial. Am J Obstet Gynecol. 2016;214(5):649.e1–8.CrossRefGoogle Scholar
  83. 83.
    Scholten RR, Hopman MTE, Lotgering FK, Spaanderman MEA. Aerobic exercise training in formerly preeclamptic women: effects on venous reserve. Hypertension. 2015;66(5):1058–65.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  • Franziska Pettit
    • 1
  • George Mangos
    • 1
  • Mark A. Brown
    • 1
    Email author
  1. 1.Department of Renal Medicine and St. George Hospital Clinical SchoolSt. George Hospital and University of NSWSydneyAustralia

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