Long-Term Consequences of Placental Vascular Pathology on the Maternal and Offspring Cardiovascular Systems

Abstract

Over the last thirty years, evidence has been accumulating that Hypertensive Disorders of Pregnancy (HDP) and, specifically, Preeclampsia (PE) produce not only long-term effects on the pregnant woman, but have also lasting consequences for the fetus. At the core of these consequences is the phenomenon known as defective deep placentation, being present in virtually every major obstetrical syndrome. The profound placental vascular lesions characteristic of this pathology can induce long-term adverse consequences for the pregnant woman’s entire arterial system. In addition, placental growth restriction and function can, in turn, cause a decreased blood supply to the fetus, with long-lasting effects. Women with a history of HDP have an increased risk of Cardiovascular Diseases (CVD) compared with women with normal pregnancies. Specifically, these subjects are at a future higher risk of: Hypertension; Coronary artery disease; Heart failure; Peripheral vascular disease; Cerebrovascular accidents (Stroke); CVD-related mortality. Vascular pathology in pregnancy and CVD may share a common etiology and may have common risk factors, which are unmasked by the “stress” of pregnancy. It is also possible that the future occurrence of a CVD may be the consequence of endothelial dysfunction generated by pregnancy-induced hypertension that persists after delivery. Although biochemical and biophysical markers of PE abound, information on markers for a comparative evaluation in the various groups is still lacking. Long-term consequences for the fetus are an integral part of the theory of a fetal origin of a number of adult diseases, known as the Barker hypothesis. Indeed, intrauterine malnutrition and fetal growth restriction represent significant risk factors for the development of chronic hypertension, diabetes, stroke and death from coronary artery disease in adults. Other factors will also influence the development later in life of hypertension, coronary and myocardial disease; they include parental genetic disposition, epigenetic modifications, endothelial dysfunction, concurrent intrauterine exposures, and the lifestyle of the affected individual.

Pathogenesis of the obstetric antiphospholipid syndrome: the key role of beta 2 glycoprotein I

“…Owing to the link between the defective placentation in preeclampsia and other pregnancy disorders and vascular lesions in the arterial system [27], it is useful to speculate on the role of the autoimmune response against β2GPI in maternal vascular damage. For example, T lymphocytes specific for β2GPI have been reported in atherosclerotic plaques of APS patients with systemic lupus erythematosus and found to be responsible for the local production of inflammatory cytokines (i.e.…”

The “brain-heart-gut” axis and novel mechanisms of future cardiovascular disease

“…"Water-Air-Radiation-Sound (WARS)" pollutions (e.g., e-noise) (56)(57)(58) greatly increase the hazard of fCVD (acute myocardial infarction, stroke). Third, internal environment with a genetic or family history, new or traditional modifiable risk factors (59), is a critical variable, such as maternal adverse pregnancy outcomes (preterm birth, low birth weight) (60,61) as well as acute or chronic infection, e.g., COVID-19 (2), abnormal blood pressure, diabetes, dyslipidemia, hyperuricemia, and obesity. A recent study found that a genetic factor (ABO genotype) can alter the composition of the gut microbiota (62), and this is a strong evidence for internal environment associated with human health.…”

Reviewing Accuracy of First Trimester Screening for Preeclampsia Using Maternal Factors and Biomarkers

“…17 Ex-utero, these changes are maladaptive with the consequence of an increased risk of hypertension and cardiovascular disease in later life. 17,18 There are estimated to be between 70-80,000 annual maternal deaths and 500,000 annual perinatal deaths secondary to preeclampsia, with 99% of these mortalities occurring in low to middle income countries (LMIC). 19 In high income countries, 90% of preeclampsia is late onset 20 which -although it carries maternal risk of eclampsia, HELLP and other hypertensive complications -has an improved neonatal prognosis.…”