Original Research
Obstetrics
Effect of early-onset preeclampsia on cardiovascular risk in the fifth decade of life

https://doi.org/10.1016/j.ajog.2017.02.015Get rights and content

Background

Women with hypertensive disorders in pregnancy, in particular early-onset preeclampsia, are at increased risk of developing cardiovascular disease later in life. These women have a more than 2-fold increased risk of dying from cardiovascular diseases. Most studies have focused on identification of risk factors shortly after pregnancy. Less is known on the prevalence of risk factors or actual signs of cardiovascular disease 5–20 years later. The presence of hypertension or metabolic syndrome can be seen as an opportunity for preventive interventions to reduce the development of severe cardiovascular diseases like myocardial infarction and stroke.

Objective

To assess cardiovascular risk factors and established cardiovascular disease in women after early-onset preeclampsia, in the fifth decade of life. As a consequence, we can assess whether there is still a window of opportunity for preventive measures and to establish in what proportion of women cardiovascular disease already has developed.

Study Design

In a prospective observational study, cardiovascular risk assessment was performed in women with early-onset preeclampsia (<34 weeks’ gestation) and normotensive controls (≥37 weeks’ gestation) 9−16 years after their index pregnancy. Medical records of 2 tertiary hospitals in Amsterdam, The Netherlands, were screened consecutively, and all eligible women were invited. Cardiovascular risk assessment consisted of a questionnaire, blood pressure measurement, anthropometrics, and blood and urine for fasting lipids, lipoproteins, glucose levels, glycated hemoglobin, renal function, N-terminal brain natriuretic peptide, and albuminuria. History of cardiovascular diseases (ie, myocardial infarction and stroke) was determined. Prevalence of women presenting in an optimal window of opportunity for preventive measures was defined by the presence of cardiovascular risk factors (ie, hypertension and metabolic syndrome) but in the absence of established cardiovascular diseases (ie, myocardial infarction and stroke).

Results

Women with a history of early-onset preeclampsia (n = 131) had significantly greater systolic and diastolic blood pressure, greater body mass index, more often had an abnormal lipid profile (lower high-density lipoprotein levels, higher triglycerides), greater glycated hemoglobin, and greater levels of albuminuria compared to controls (n = 56). None of the women with a history of early-onset preeclampsia was diagnosed with cardiovascular disease; 38.2% were diagnosed with hypertension; and 18.2% were diagnosed with metabolic syndrome. A total of 42% met the criteria for the window of opportunity for preventive measures. In women with a history of an uncomplicated pregnancy, no women were diagnosed with cardiovascular disease; 14.3% were diagnosed with hypertension; 1.8% with metabolic syndrome. In this cohort, 14.3% met the criteria for the window of opportunity for preventive measures.

Conclusion

A large proportion of women who experienced early-onset preeclampsia had major cardiovascular risk factors in the fifth decade of life, compared with healthy controls. These women are currently outside the scope of most preventive programs due to their relatively young age, but have important modifiable risk factors for cardiovascular diseases.

Section snippets

Study population

All women were recruited from obstetrical databases of 2 tertiary medical centers in the Netherlands, all giving birth between 1998 and 2005. Medical records of women with a history of early-onset preeclampsia were screened consecutively, and all eligible women were invited. Participating women with a history of early-onset preeclampsia were matched with women with an uncomplicated pregnancy, for maternal age (range ± 5 years) and date of delivery (range ± 1 year). Early-onset preeclampsia was

Results

The baseline characteristics at index pregnancy are described in Table 1. Women with a history of early-onset preeclampsia were younger at delivery (P = .046), more often were primiparous (P = .001), and more often delivered via caesarean delivery (P < .0001) compared with women with an uncomplicated pregnancy history. As expected, the women with former early-onset preeclampsia had greater blood pressures during pregnancy (P < .0001). In addition, they had a shorter gestational age (P < .0001),

Comment

Women with a history of early-onset preeclampsia who were in the fifth decade of life had high rates of cardiovascular risk factors, although cardiovascular diseases had not developed yet. As a result, the women could still benefit from measures preventing cardiovascular disease. We conclude that there is a window of opportunity for preventive measures in women in their forties, for those who have a history of early-onset preeclampsia (42%).

We have found that 38.2% of women with early-onset

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    The authors report no conflict of interest.

    This research was funded, in part, by a grant from the Dutch Heart Association.

    Cite this article as: Bokslag A, Teunissen PW, Franssen C, et al. Effect of early-onset preeclampsia on cardiovascular risk in the fifth decade of life. Am J Obstet Gynecol 2017;216:523.e1-7.

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