Pregnancy-associated risk factors for future cardiovascular disease – early prevention strategies warranted

Abstract

We summarize convincing evidence that future cardiovascular disease (CVD) risk increases one-fold to four-fold for women with a history of pregnancy complicated by hypertensive disorders, gestational diabetes, fetal growth restriction, placental abruption and preterm birth. A concomitant occurrence of two or more complications in the same pregnancy further potentiates the risk. These women should be informed of their future CVD risks during the postpartum check-up taking place after delivery, and also, if needed, treated, for example, for persisting high blood pressure. In these women with high blood pressure, check-up should take place within 7–10 days, and if severe hypertension, within 72 h. Women without diagnostic signs and symptoms should be examined for the first time 1–2 years postpartum and then at intervals of 2–3 years for a complete CVD risk profile including clinical and laboratory assessments. Women should be informed for future CVD risks and their effective prevention with healthy lifestyle factors. Combined oral contraceptives should be avoided or used with caution. If laboratory or other clinical findings indicate, then vigorous treatments consisting of non-medical and medical (antihypertensives, statins, antidiabetic and anti-obesity therapies) interventions should be initiated early with liberal indications and with ambitious therapeutic goals. Low-dose aspirin and menopausal hormone therapy should be used in selected cases. Active control and treatment policies of these women with pregnancy-related risks will likely result in decreases of CVD occurrence in later life.

摘要

我们总结了有力的证据, 表明妊娠并发高血压疾病、妊娠糖尿病、胎儿生长受限、胎盘早剥和早产的女性, 未来心血管疾病（CVD）风险增加了一到四倍。一次妊娠中两种或更多并发症的同时发生进一步增加了风险。这些女性应该在分娩后进行产后检查, 了解其未来的CVD风险, 并在必要时接受治疗, 例如持续高血压。对于这些患有高血压的女性, 检查应在产后7-10天内进行, 如果是严重高血压, 则在72小时内进行。对于没有诊断迹象和症状的女性, 应在产后1-2年进行首次检查, 然后每2-3年进行一次全面的CVD风险评估, 包括临床和实验室评估。女性应该被告知未来的CVD风险以及通过健康的生活方式因素进行有效预防。应避免或谨慎使用复方口服避孕药。如果实验室或其他临床发现提示, 那么应该早期进行非药物和药物（抗高血压药、他汀类药物、抗糖尿病和抗肥胖疗法）的干预, 可以放宽适应症并期待更好的治疗目标。低剂量阿司匹林和绝经激素疗法应在特定情况下使用。对这些有妊娠相关风险的女性采取积极的管理和治疗可能会降低晚年CVD的发病率。

Keywords:

• Postmenopausal
• menopause
• pre-eclampsia
• hormone replacement therapy
• pregnancy
• delivery
• vascular

Acknowledgements

The authors warmly thank Associate Professor Nina Mero-Matikainen, M.D., for critical review and comments during manuscript preparation.

Potential conflict of interest

No potential conflict of interest was reported by the authors.

Source of funding

None.