Pregnancy complications and later life women's health

Abstract

There has been increasing recognition of the association between various pregnancy complications and development of chronic disease in later life. Pregnancy has come to be regarded as a physiological stress test, as the strain it places on a woman's body may reveal underlying predispositions to disease that would otherwise remain hidden for many years. Despite the increasing body of data, there is a lack of awareness among healthcare providers surrounding these risks. We performed a narrative literature review and have summarized the associations between the common pregnancy complications including gestational hypertension, pre-eclampsia, gestational diabetes, placental abruption, spontaneous preterm birth, stillbirth and miscarriage and subsequent development of chronic disease. Hypertensive disorders of pregnancy, spontaneous preterm birth, gestational diabetes, pregnancy loss and placental abruption are all associated with increased risk of various forms of cardiovascular disease.Gestational diabetes, pre-eclampsia, early miscarriage and recurrent miscarriage are associated with increased risk of diabetes mellitus. Pre-eclampsia, stillbirth and recurrent miscarriage are associated with increased risk of venous thromboembolism. Cardiovascular-related morbiditya OR 1.67 (95% ICI: 1.28-2.19) 14 Cerebrovascular morbidity OR 1.83 (95% ICI: 0.79-4.22) 14 Note: Statistics quoted as per reporting study. Abbreviation: OR, odds ratio. a Including coronary artery disease, myocardial infarction, coronary revascularization, peripheral arterial disease, transient ischemic attack, and stroke.

Pregnancy‐associated mortality due to cardiovascular disease: Impact of hypertensive disorders of pregnancy

“…Hypertensive disorders of pregnancy (HDP), including chronic hypertension, gestational hypertension, preeclampsia, eclampsia, and superimposed preeclampsia, are common obstetrical complications that occur in approximately 10% of pregnancies worldwide; 14,15 in addition, the prevalence of gestational hypertension, preeclampsia and eclampsia has been increasing in the United States between 2010 (8.9%) and 2019 (14.9%) 13 . Preeclampsia has been implicated in chronic health conditions along the life course, 16 with studies reporting a 2‐fold increase in associated rates of all‐cause mortality and premature death, 4,14 and up to a 3‐fold higher mortality rate for ischaemic heart disease, heart failure, hypertension, stroke 17 and CVD 14 in relation to preeclampsia. Preeclampsia/eclampsia rates increased by 25% from 1987 to 2004 in the United States 18,19 and have continued to increase from 2010 (4.7%) to 2019 (7.7%) 13 .…”

Are fetal microchimerism and circulating fetal extracellular vesicles important links between spontaneous preterm delivery and maternal cardiovascular disease risk?

“…[ 1 ] It is recognized that compromise in the mother's health is an important contributor to disease burden. [ 2 ] This is true not only for the index pregnancy and postpartum period but also for subsequent pregnancies, as the strongest risk factor for PTB is a previous PTB. In addition, as we argue below, spontaneous preterm delivery carries an increased lifetime maternal risk for cardiovascular diseases (CVDs) and stroke, even when adjusted for co‐morbidities like smoking, obesity, diabetes mellitus, and hypertensive disorders of pregnancy.…”

Protocol for cost-effectiveness analysis of a randomised trial of mHealth coaching (Bump2Baby and Me) compared to usual care for healthy gestational weight gain and postnatal outcomes in at-risk women and their offspring

“…GDM is associated with increased likelihood of pregnancy complications including pre-eclampsia, infection, obstructed labour, caesarean delivery and postpartum hemorrhage (9)(10)(11)(12). GDM also increases long-term chronic condition risk for type 2 diabetes and hypertension as well as other complications related to cardiovascular diseases (13)(14)(15)(16)). Pre-term birth and special or intensive care nursery admission increases for infants born to women with GDM (12).…”