Pre-eclampsia is associated with a four-fold increase in future incident heart failure and a two-fold increased risk of coronary heart disease, stroke, and death because of coronary heart or cardiovascular disease, found a Keele University study.
The research also found that expectant mothers with pre-eclampsia, which presents with high blood pressure and protein in the woman's urine, have a two-fold increase risk of coronary heart disease, stroke and death due to cardiovascular disease in later life.
Pre-eclampsia affects 5% to 8% of pregnancies and is the most common cause of severe ill-health during pregnancy which can, in extreme circumstances, lead to death of the mother or baby.
The findings involved the analysis of 22 studies and more than 6.5m women. The authors of the study are calling for doctors to offer better advice to women about the increased risks, and the actions they can take to avoid future ill-health.
Dr Pensee Wu, the first author of this publication and lecturer in obstetrics and gynaecology at Keele University, said: "Doctors need to be aware of the importance of educating women about their increased level of cardiovascular risk and of advising women about the beneficial effects of changing their lifestyle, such as increasing their level of physical activity and not smoking. I hope this work will raise awareness amongst hospital doctors of the advice that they need to give to women with pre-eclampsia."
Wu, who is also an honorary consultant obstetrician and maternal foetal medicine sub-specialist at University Hospital of North Midlands NHS Trust, added: "The study shows the risk is highest during the first ten years after a pregnancy affected by pre-eclampsia, so it is important that women are regularly monitored during this period for cardiovascular risk factors such as high blood pressure, high cholesterol and obesity."
"The risks begins to increase for coronary heart disease, heart failure and stroke within one year after giving birth, but it is highest between one to ten years after giving birth."
The analysis was a collaboration between researchers at Keele University's Institute for Applied Clinical Science (iACS) and Institute for Science & Technology in Medicine (ISTM), along with primary care and health sciences (iPCHS), and the University Hospital of North Midlands NHS Trust (UHNM).
Dr Randula Haththotuwa, co-author, academic clinical fellow, and trainee GP funded by the National Institute for Health Research, added: "This study is extremely important for general practice as it will highlight the importance of lifelong monitoring of women who have suffered from pre-eclampsia of cardiovascular risk factors."
Last year, Wu, Haththotuwa and their collaborators published another paper identifying a link between pre-eclampsia in pregnancy and the development of diabetes in later life. The study showed that pre-eclampsia is independently associated with a two-fold increase in future diabetes. This increased risk was found to occur from less than one year after delivery of the baby and persisted to over ten years after birth. Again, this highlights the need for monitoring of women in primary care.
Abstract
Background: Preeclampsia is a pregnancy-specific disorder resulting in hypertension and multiorgan dysfunction. There is growing evidence that these effects persist after pregnancy. We aimed to systematically evaluate and quantify the evidence on the relationship between preeclampsia and the future risk of cardiovascular diseases.
Methods and Results: We studied the future risk of heart failure, coronary heart disease, composite cardiovascular disease, death because of coronary heart or cardiovascular disease, stroke, and stroke death after preeclampsia. A systematic search of MEDLINE and EMBASE was performed to identify relevant studies. We used random-effects meta-analysis to determine the risk. Twenty-two studies were identified with >6.4 million women including >258 000 women with preeclampsia. Meta-analysis of studies that adjusted for potential confounders demonstrated that preeclampsia was independently associated with an increased risk of future heart failure (risk ratio [RR], 4.19; 95% confidence interval [CI], 2.09–8.38), coronary heart disease (RR, 2.50; 95% CI, 1.43–4.37), cardiovascular disease death (RR, 2.21; 95% CI, 1.83–2.66), and stroke (RR, 1.81; 95% CI, 1.29–2.55). Sensitivity analyses showed that preeclampsia continued to be associated with an increased risk of future coronary heart disease, heart failure, and stroke after adjusting for age (RR, 3.89; 95% CI, 1.83–8.26), body mass index (RR, 3.16; 95% CI, 1.41–7.07), and diabetes mellitus (RR, 4.19; 95% CI, 2.09–8.38).
Conclusions: Preeclampsia is associated with a 4-fold increase in future incident heart failure and a 2-fold increased risk in coronary heart disease, stroke, and death because of coronary heart or cardiovascular disease. Our study highlights the importance of lifelong monitoring of cardiovascular risk factors in women with a history of preeclampsia.
Authors
Pensée Wu, Randula Haththotuwa, Chun Shing Kwok, Aswin Babu, Rafail A Kotronias, Claire Rushton, Azfar Zaman, Anthony A Fryer, Umesh Kadam, Carolyn A Chew-Graham and Mamas A Mamas
[link url="https://www.keele.ac.uk/pressreleases/2017/studyrevealspre-eclampsiasignificantlyincreasesriskofheartdiseaseinlat.html"]Keele University material[/link]
[link url="http://circoutcomes.ahajournals.org/content/10/2/e003497"]Circulation: Cardiovascular Quality and Outcomes abstract[/link]