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Pregnancy as 'Stress Test' Could Predict Future CV Health Risks


 

TORONTO — Pregnancy could be viewed as a type of cardiovascular “stress test” that could uncover previously silent risk factors for future cardiovascular problems, according to Carl H. Hubel, Ph.D.

“Studying women during pregnancy may facilitate the identification of cardiovascular risk and offer an opportunity for early intervention to decrease their likelihood of developing problems later in life,” said Dr. Hubel of Magee Women's Research Institute in Pittsburgh.

Speaking at the annual meeting of the Society for Gynecologic Investigation, Dr. Hubel outlined his own work and that of other researchers that both show that preeclampsia and other complications relating to placental insufficiency such as low birth weight and preterm delivery are associated with an increased risk of cardiovascular events up to 30 years later.

“Metabolic factors predisposing to endothelial dysfunction such as insulin resistance, dyslipidemia, and inflammation may also predispose to preeclampsia and may later manifest as cardiovascular disease,” he said, suggesting that endothelial repair is a potential target on the horizon. “Surveillance of cardiovascular risk factors during pregnancy per se may help to identify additional subsets of women who would benefit from early and aggressive risk factor modification post partum.”

In a study of 30 women with a previous eclamptic pregnancy, Dr. Hubel and his colleagues found that 33% were taking blood pressure medications 30 years after the index pregnancy, compared with only 7% of controls (BJOG 2000;107:776–84). More recently, the same group of women also showed increased levels of C-reactive protein (CRP), an inflammatory marker of cardiovascular disease risk—and a higher prevalence of dyslipidemia, and insulin resistance compared with controls.

“We cannot rule out that preeclampsia is the cause, not the consequence, of these risk factors,” he said in an interview. “Preeclampsia has a prevalence rate of 3%–5% of pregnancies—so one would have to follow large numbers of women from preconception, through their pregnancies, and into later life just to capture enough women who develop preeclampsia to determine the answer.”

But regardless of this, he suggests women who have had preeclampsia, preterm birth, or a low-birth-weight baby should be monitored more closely for risk factors that might contribute to future cardiovascular risk.

“Perhaps this is a group of women that shouldn't wait until after age 45 to have their CRP and lipids measured,” Dr. Hubel said.

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