Cardiovascular risk management after reproductive and pregnancy-related disorders: A Dutch multidisciplinary evidence-based guideline

Heida, Karst Y.; Bots, Michiel L.; Groot, Christianne de; Dunné, Frederique M. van; Hammoud, Nurah M.; Hoek, A. van den; Laven, Joop; Maas, Angela H.E.M.; Lennep, Jeanine E. Roeters van; Velthuis, Birgitta K.; Franx, Arie

doi:10.1177/2047487316659573

Cited by 136 publications

(113 citation statements)

References 83 publications

(90 reference statements)

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“…Meanwhile, a first guideline for follow-up of patients after previous PE has appeared, whereby optimization of modifiable cardiovascular risk factors is recommended for reproductive and pregnancy-related disorders to reduce the risk of future CVD (206). Progress will eventually become inevitable as focused patient history taking, pregnancy risk algorithms, and the existing obstetric care platform already meet WHO criteria for screening tests (207).…”

Section: Discussionmentioning

confidence: 99%

Pregnancy: An Underutilized Window of Opportunity to Improve Long-term Maternal and Infant Health—An Appeal for Continuous Family Care and Interdisciplinary Communication

2017

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Physiologic adaptations during pregnancy unmask a woman’s predisposition to diseases. Complications are increasingly predicted by first-trimester algorithms, amplify a pre-existing maternal phenotype and accelerate risks for chronic diseases in the offspring up to adulthood (Barker hypothesis). Recent evidence suggests that vice versa, pregnancy diseases also indicate maternal and even grandparent’s risks for chronic diseases (reverse Barker hypothesis). Pub-Med and Embase were reviewed for Mesh terms “fetal programming” and “pregnancy complications combined with maternal disease” until January 2017. Studies linking pregnancy complications to future cardiovascular, metabolic, and thrombotic risks for mother and offspring were reviewed. Women with a history of miscarriage, fetal growth restriction, preeclampsia, preterm delivery, obesity, excessive gestational weight gain, gestational diabetes, subfertility, and thrombophilia more frequently demonstrate with echocardiographic abnormalities, higher fasting insulin, deviating lipids or clotting factors and show defective endothelial function. Thrombophilia hints to thrombotic risks in later life. Pregnancy abnormalities correlate with future cardiovascular and metabolic complications and earlier mortality. Conversely, women with a normal pregnancy have lower rates of subsequent diseases than the general female population creating the term: “Pregnancy as a window for future health.” Although the placenta works as a gatekeeper, many pregnancy complications may lead to sickness and earlier death in later life when the child becomes an adult. The epigenetic mechanisms and the mismatch between pre- and postnatal life have created the term “fetal origin of adult disease.” Up to now, the impact of cardiovascular, metabolic, or thrombotic risk profiles has been investigated separately for mother and child. In this manuscript, we strive to illustrate the consequences for both, fetus and mother within a cohesive perspective and thus try to demonstrate the complex interrelationship of genetics and epigenetics for long-term health of societies and future generations. Maternal–fetal medicine specialists should have a key role in the prevention of non-communicable diseases by implementing a framework for patient consultation and interdisciplinary networks. Health-care providers and policy makers should increasingly invest in a stratified primary prevention and follow-up to reduce the increasing number of manifest cardiovascular and metabolic diseases and to prevent waste of health-care resources.

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Section: Discussionmentioning

confidence: 99%

Pregnancy: An Underutilized Window of Opportunity to Improve Long-term Maternal and Infant Health—An Appeal for Continuous Family Care and Interdisciplinary Communication

2017

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“…Pregnancy represents a 'stress test' on a woman's physiology and may therefore act as an early warning mechanism by unmasking underlying cardiovascular issues. [46][47][48] There is some evidence that reproductive and pregnancy-associated disorders, including those affecting fertility such as polycystic ovary syndrome and premature ovarian insufficiency, could be useful indicators for future cardiovascular disease. 46,48 However, more research is needed in order to evaluate which obstetric events are meaningful markers that a woman is at increased risk of developing cardiovascular risk later in life and how best to act on them.…”

Section: Long-term Cardiovascular Risk Of Ftsmentioning

confidence: 99%

Pregnancy and cardiovascular risk: A review focused on women with heart disease undergoing fertility treatment

Rossberg

Stangl

2016

Eur J Prev Cardiolog

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A growing number of women with heart disease are considering pregnancy with the help of assisted reproductive technology (ART). Although an ever-increasing amount of knowledge exists on pregnancy in both congenital and acquired heart disease patients, little information is available on fertility treatments specifically in these women. This review seeks to provide an overview of the existing data and explores areas in need of research in this field. Changes in the hormonal environment seen in ART patients initially entail an increase then a decrease in blood pressure and peripheral vascular resistance. A shift in the thrombotic-thrombolytic balance towards coagulation is observed. Compared to normal pregnancy, ART-conceived pregnancies exhibit an increased adverse event rate for both the mother and foetus, including a higher incidence of hypertensive disorders and an increase in thromboembolic events during the first trimester. Ovarian hyperstimulation syndrome in particular can cause dramatic haemodynamic changes and an increase in upper body thrombosis. Viewing these findings within the context of women with an underlying heart disease reveals indications that maternal and neonatal complications after fertility treatments are higher. Pre-pregnancy risk assessment is essential to identifying women with heart disease for whom ART may be dangerous and therefore inappropriate.

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“…Less severe forms of HDP are also associated with an increased risk for coronary heart disease with RRs ranging from 1.3 to 2.2,3 4 an increased risk for stroke ranging from 1.3 to 1.93–5 and an increased risk for overall CVD ranging from 1.3 to 2.8 6…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, pregnancy might be a ‘window of opportunity’ for physicians to identify women with increased risk of CVD and improve their cardiovascular health 8. Furthermore, two recent papers reported that up to 30% of women with HDP develop chronic hypertension after pregnancy and advocated close after-pregnancy surveillance by their physician9 10 in line with the Dutch recommendation 6…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular risk model performance in women with and without hypertensive disorders of pregnancy

Dam

Onland‐Moret

Boer

et al. 2018

Heart

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Cardiovascular risk management after reproductive and pregnancy-related disorders: A Dutch multidisciplinary evidence-based guideline

Abstract: Based on the current available evidence, follow-up is only recommended for women with a history of preeclampsia. For all reproductive and pregnancy-related disorders optimisation of modifiable cardiovascular risk factors is recommended to reduce the risk of future CVD.

Cited by 136 publications

References 83 publications

Pregnancy: An Underutilized Window of Opportunity to Improve Long-term Maternal and Infant Health—An Appeal for Continuous Family Care and Interdisciplinary Communication

Pregnancy: An Underutilized Window of Opportunity to Improve Long-term Maternal and Infant Health—An Appeal for Continuous Family Care and Interdisciplinary Communication

Pregnancy and cardiovascular risk: A review focused on women with heart disease undergoing fertility treatment

Cardiovascular risk model performance in women with and without hypertensive disorders of pregnancy

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