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"The only group in the U.S. that isn’t seeing a reduction in cardiovascular mortality is women ages 35 to 45. We have an opportunity to affect this statistic right now by better identifying and treating women who have had preeclampsia, pregnancy-induced hypertension or gestational diabetes."

-Ashley Simmons, MD

Preeclampsia suggests long-term cardiovascular risk management

By Ashley Simmons, MD, FACC, cardiologist

Ashley SimmonsThe incidence of preeclampsia is growing, likely due in part to increased obesity and maternal age. We now know that preeclampsia, pregnancy-induced hypertension and gestational diabetes all result in diffuse endothelial dysfunction that increases the lifetime risk for cardiovascular disease – a risk we can manage only if we remain alert and aware.

Preeclampsia risk equal to failed stress test 

Having a diagnosis of preeclampsia puts a woman at equal cardiovascular risk as someone who has failed a stress test. Multiple studies have found clear connections between gestational hypertension, preeclampsia, eclampsia and isolated systolic hypertension and increased risk for heart failure, MI and MI death, ischemic cerebrovascular disease, diabetes mellitus and chronic kidney disease.

Women with preeclampsia are:

  • Three times more likely to develop diabetes
  • Four times more likely to develop hypertension requiring treatment
  • Twice as likely to suffer stroke or heart attack
  • At increased risk for chronic renal disease

Detection

About 5-8% of all pregnancies are affected by preeclampsia, which can cause seizures and placental abruption, inhibit growth of the fetus and cause preterm labor. Preeclampsia is characterized by high blood pressure and often detected after 20 weeks gestation by the presence of protein in the urine. Most cases of preeclampsia occur during pregnancy, but it can appear during delivery or up to six weeks postpartum. Some women experience symptoms including swelling, headaches, changes in vision, lower back pain and sudden weight gain. Others experience no symptoms at all.

Risk factors

Pregnancy causes decreased vascular resistance, increased blood volume and other metabolic changes, requiring the cardiovascular system to adapt. Several existing factors can put a woman at risk for preeclampsia as well.

High

  • Hypertensive disease during previous pregnancy
  • Chronic kidney disease
  • Autoimmune disease such as lupus or antiphospholipid antibody syndrome
  • Type 1 or 2 diabetes
  • Chronic hypertension

Moderate

  • First pregnancy
  • Over age 40 or under 18
  • Family history
  • Pregnancy interval of more than 10 years
  • Carrying multiples
  • Overweight or obese

Stringent follow-up required

The American Heart Association classifies a previous history of preeclampsia or gestational diabetes as a major cardiovascular risk factor, alongside conditions such as hypertension and hypercholesterolemia, and other factors such as smoking, physical inactivity, obesity and family history.

When evaluating a woman’s cardiovascular risk, primary care physicians must include an understanding of her pregnancy history – whether she was diagnosed with preeclampsia or had any hypertension during pregnancy.

In the OB/GYN setting, these women should be monitored postpartum much more closely than those without such complications. We recommend:

  • Running lipid and glucose profiles at six months postpartum
  • Ensuring hypertension is resolved before the next pregnancy
  • Recommending lifestyle changes to decrease cardiovascular risk, including smoking cessation, a heart-healthy diet, regular exercise and stress management
  • Considering  follow-up with an internist or cardiologist, especially if hypertension persists

Dr. Simmons is a cardiologist and medical director of the women’s heart health program at The University of Kansas Hospital. She is certified in cardiovascular disease by the American Board of Internal Medicine and in adult comprehensive echocardiography by the National Board of Echocardiography.

Consult with a physician online. Or call 913-588-5862 or toll-free 877-588-5862.