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Endothelial Dysfunction Remains 1 Year After Preeclamptic Pregnancy


 

STOCKHOLM — Marked maternal endothelial dysfunction remains present a full year after a preeclamptic pregnancy, Maria J. Eriksson, M.D., Ph.D., reported at the annual congress of the European Society of Cardiology.

One year post partum, women with a history of preeclampsia have significantly higher blood pressure and fasting insulin and blood glucose levels than healthy controls who had a normal pregnancy. These physiologic and metabolic abnormalities help explain the association between preeclampsia and increased risk of cardiovascular disease, said Dr. Eriksson of Karolinska University, Stockholm.

She presented a 1-year follow-up on 18 women who had moderate to severe preeclampsia in their first pregnancy and 17 age-matched controls with an uncomplicated pregnancy.

Brachial artery flow-mediated vasodilation as assessed by ultrasound—a standard noninvasive tool for the identification of endothelial dysfunction—was 2.5% in women with a history of preeclampsia, compared with 10.3% in controls. Flow-mediated dilation measured 1 year post pregnancy correlated directly with birth weight and gestational age, and inversely with maximum systolic blood pressure in pregnancy. But it is unclear whether this endothelial dysfunction was induced by the preeclamptic process or reflected a predisposition to it.

Twenty-four hour ambulatory blood pressure monitoring demonstrated that average daytime blood pressures in women 1 year post preeclampsia were 123/81 mm Hg, compared with 116/76 mm Hg in controls. Mean arterial pressure averaged 95 mm Hg in formerly preeclamptic subjects and 90 mm Hg in controls.

Fasting insulin and blood glucose was 4.6 mmol/L and 46 pmol/L, respectively, in women with a history of preeclampsia, compared with 4.4 mmol/L and 30 pmol/L in controls, suggesting insulin resistance as a therapeutic target for prevention of recurrent preeclampsia.

There were no significant differences between the two groups in terms of blood lipids. Nor did they differ in terms of levels of inflammatory markers or hemostatic factors.

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