Analyzing Preeclampsia as the Tip of the Iceberg Represented by Women with Long-Term Cardiovascular Disease, Atherosclerosis, and Inflammation

Diniz, Angélica Lemos Debs; Paes, Maria Marta Bini Martins; Diniz, A.D.

doi:10.1007/s11883-020-0830-6

Cited by 14 publications

(6 citation statements)

References 50 publications

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“…Hypertensive disorders of pregnancy (HDP), including preeclampsia (PEC), are common pregnancy complications that affect long-term cardiovascular health. 1 Adverse pregnancy outcomes, including PEC, gestational diabetes mellitus (GDM), and preterm birth, are increasingly recognized as important contributors to cardiovascular disease (CVD) risk in women. 2,3 Multiple large cohort studies have shown an increase in morbidity and mortality in women with a history of HDP driven by diabetes mellitus, ischemic heart disease, and stroke.…”

Section: Introductionmentioning

confidence: 99%

Postpartum counseling in women with hypertensive disorders of pregnancy

Triebwasser

Janssen

Sehdev

2021

American Journal of Obstetrics & Gynecology MFM

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BACKGROUND: Hypertensive disorders of pregnancy are associated with increased cardiovascular disease risk across the lifespan. The American College of Obstetricians and Gynecologists and the American Heart Association emphasize the postpartum period as an important opportunity to identify and intervene women at high risk of future cardiovascular disease. OBJECTIVE: This study aimed to determine the proportion of women with documented counseling on risks and transitions of care after hypertensive disorders of pregnancy at the postpartum visit. STUDY DESIGN: This was a retrospective longitudinal descriptive study of women with hypertensive disorders of pregnancy who were enrolled in a text-based blood pressure program from September 2018 to February 2019. We abstracted counseling in the discharge summary and postpartum note from the electronic medical record. The primary outcome was counseling at the postpartum visit defined as documentation of (1) follow-up with primary care or cardiology, (2) risk of cardiovascular disease, or (3) recommendation for aspirin in a future pregnancy. We assessed demographic and clinical factors that may influence counseling through multivariable logistic regression. We also compared the proportion of women counseled on hypertensive disorders of pregnancy vs contraception and glucose tolerance tests at the postpartum visit.RESULTS: Of 320 eligible women, most women had gestational hypertension or preeclampsia without severe features (64%). Postpartum visits were scheduled in our hospital system for 284 women, of whom 253 attended (89%). Documented counseling occurred for 62 women (25%). Counseling on follow-up with primary care or cardiology, cardiovascular disease risk, and aspirin in future pregnancies was documented for 51 (20%), 15 (6%), and 1 (0.4%), respectively. Only 1 woman had documented counseling on all 3 components. In multivariable analysis, black race remained an independent factor that increased the likelihood of counseling on hypertensive disorders of pregnancy (adjusted odds ratio, 2.77; 95% confidence interval, 1.32e5.83). Women were significantly less likely to be counseled on hypertensive disorders of pregnancy than on contraceptives (99%, P<.001) or glucose tolerance testing after gestational diabetes mellitus (79%, P<.001). CONCLUSION: Postpartum counseling on hypertensive disorders of pregnancy merits urgent improvement efforts among obstetrical care providers.

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Section: Introductionmentioning

confidence: 99%

Postpartum counseling in women with hypertensive disorders of pregnancy

Triebwasser

Janssen

Sehdev

2021

American Journal of Obstetrics & Gynecology MFM

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“…PE is a complex and pregnancy-specific hypertensive syndrome. It is reported that women who have developed PE in pregnancy are at increased risk of cardiovascular disease, coronary artery calcification, stroke, and chronic kidney disease later life [ 10 , 11 , 12 , 13 , 14 ]. PE is characterized by hypertension and proteinuria after 20 weeks’ gestation, and is frequently associated with placental dysfunction, although the etiology remains unknown at the molecular level [ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Inorganic Phosphate in the Pathogenesis of Pregnancy-Related Complications

Correia-Branco

Rincón²,

Pereira³

et al. 2020

IJMS

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Inorganic phosphate (Pi) is an essential nutrient that fulfills critical roles in human health. It enables skeletal ossification, supports cellular structure and organelle function, and serves key biochemical roles in energetics and molecular signaling. Pi homeostasis is modulated through diet, intestinal uptake, renal reabsorption, and mobilization of stores in bone and extracellular compartments. Disrupted Pi homeostasis is associated with phosphate wasting, mineral and bone disorders, and vascular calcification. Mechanisms of Pi homeostasis in pregnancy remain incompletely understood. The study presented herein examined biological fluid Pi characteristics over the course of gestation. Correlations with gestation age, pregnancy number, preterm birth, preeclampsia, diabetes mellitus, and placental calcification were evaluated during the last trimester. The results support that maternal urinary Pi levels increased during the third trimester of pregnancy. Reduced levels were observed with previous pregnancy. Amniotic fluid Pi levels decreased with gestation while low second trimester levels associated with preterm birth. No significant difference in urinary Pi levels was observed between preeclampsia and controls (8.50 ± 2.74 vs. 11.52 ± 2.90 mmol/L). Moreover, increased maternal urinary Pi was associated with preexisting diabetes mellitus in preeclampsia. Potential confounding factors in this study are maternal age at delivery and body mass index (BMI)—information which we do not have access to for this cohort. In conclusion, Pi levels provide clinical information regarding the pathogenesis of pregnancy-related complications, supporting that phosphate should be examined more closely and in larger populations.

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“…Many studies have linked preeclampsia with increased risk of later CVD [ 2 , 4 , 5 , 16 , 17 ]. Less is known about potential familial predisposition to both conditions [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Association between preeclampsia in daughters and risk of cardiovascular disease in parents

et al. 2023

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Preeclampsia and cardiovascular disease (CVD) might share heritable underlying mechanisms. We investigated whether preeclampsia in daughters is associated with CVD in parents. In a register-based cohort study, we used Cox regression to compare rates of CVD (ischemic heart disease, ischemic stroke, myocardial infarction) in parents with ≥ 1 daughters who had preeclampsia and parents whose daughters did not have preeclampsia in Denmark, 1978–2018. Our cohort included 1,299,310 parents, of whom 87,251 had ≥ 1 daughters with preeclampsia and 272,936 developed CVD during 20,252,351 years of follow-up (incidence rate 135/10,000 person-years). Parents with one daughter who had preeclampsia were 1.19 times as likely as parents of daughters without preeclampsia to develop CVD at age < 55 years (hazard ratio [HR] 1.19, 95% confidence interval [CI] 1.13–1.25). Having ≥ 2 daughters who had preeclampsia yielded an HR of 1.88 (95% CI 1.39–2.53). The corresponding HRs for CVD at ≥ 55 years of age were 1.13 (95% CI 1.12–1.15) and 1.27 (95% CI 1.16–1.38). Patterns of association were similar for all CVD subtypes. Effect magnitudes did not differ for mothers and fathers (p = 0.52). Analyses by timing of preeclampsia onset in daughters suggested a tendency toward stronger associations with earlier preeclampsia onset, particularly in parents < 55 years. Preeclampsia in daughters was associated with increased risks of CVD in parents. Increasing strength of association with increasing number of affected daughters, equally strong associations for mothers and fathers, and stronger associations for CVD occurring before age 55 years suggest that preeclampsia and CVD share common heritable mechanisms.

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Analyzing Preeclampsia as the Tip of the Iceberg Represented by Women with Long-Term Cardiovascular Disease, Atherosclerosis, and Inflammation

Cited by 14 publications

References 50 publications

Postpartum counseling in women with hypertensive disorders of pregnancy

Postpartum counseling in women with hypertensive disorders of pregnancy

Inorganic Phosphate in the Pathogenesis of Pregnancy-Related Complications

Association between preeclampsia in daughters and risk of cardiovascular disease in parents

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