Pregnancy-related conditions are increasingly recognised as important determinants of women's long-term health. Mothers with hypertensive disorders of pregnancy (HDP), such as preeclampsia and gestational hypertension, have increased cardiometabolic health risks long after delivery. It has been hypothesised that pregnancy unmasks the underlying cardiometabolic health status of women, with HDP highlighting an elevated long-term risk of vascular disease. Others suggest that HDP could also have a direct impact on vasculature, with subsequent adverse health consequences. Regardless of the underlying cause, women with HDP have a more adverse cardiometabolic profile than those with normotensive pregnancy from as soon as the first five years post-pregnancy, continuing to later life.
Several uncertainties remain, including the effect of changing demographics and pregnancy comorbidities, optimal timing for risk identification and monitoring, and what post-pregnancy interventions are effective to alter a woman's adverse cardiovascular health trajectory after HDP. International trends are for mothers to be older, more often overweight/obese, and more likely to enter pregnancy with comorbidities including hypertension and diabetes. As background cardiovascular risk profile differs in relatively young and older ages, it remains unclear if HDP's impact on long-term health differs in older versus younger age mothers. As reproductive age women are unlikely to undergo routine cardiovascular risk assessment, knowing their obstetric history might allow us to identify those at increased risk who might benefit from an early intervention. However, the impact of using obstetric history to improve risk prediction over conventional risk assessment tools remain unproven. One approach could be to monitor blood pressure levels over time, as long-term cumulative blood pressure elevation is predictive of vascular outcomes. Furthermore, existing clinical guidelines are unclear regarding optimal periods for blood pressure monitoring in women after HDP.
Women with HDP may potentially benefit from appropriate lifestyle and/or pharmacologic intervention. However, there is yet no evidence from randomised trials to demonstrate what interventions, and at what time, will be effective in reducing long-term cardiovascular risks after HDP. Determining those at highest risks to identify those who are likely to benefit from an intervention could be useful. Co-occurrence or co-existence of hypertensive disorders with other perinatal conditions (e.g., gestational diabetes), and timing of the HDP (e.g., gestational age, parity, and inter-pregnancy interval) might amplify future disease risk. Characterising and replicating these risk patterns in detail across populations and over time might give insights not just into disease mechanisms but also inform ways for improving risk prediction assessments. Whilst we focus in this review on cardiovascular disease, HDP are also associated with other chronic conditions such as diabetes. As more women with incident cardiovascular disease already present in hospitals with comorbidities, the role of pregnancy-related conditions in lifelong multimorbidity requires further investigation.
We welcome investigators to contribute their perspectives on these issues, with the view to highlighting existing evidence, knowledge gaps and future research directions. Systematic reviews and evidence-based insights would be informative in this research area. As most studies tend to involve populations in high-income countries, we would particularly welcome contributions that provide perspectives for populations from low-to-middle-income countries.
Pregnancy-related conditions are increasingly recognised as important determinants of women's long-term health. Mothers with hypertensive disorders of pregnancy (HDP), such as preeclampsia and gestational hypertension, have increased cardiometabolic health risks long after delivery. It has been hypothesised that pregnancy unmasks the underlying cardiometabolic health status of women, with HDP highlighting an elevated long-term risk of vascular disease. Others suggest that HDP could also have a direct impact on vasculature, with subsequent adverse health consequences. Regardless of the underlying cause, women with HDP have a more adverse cardiometabolic profile than those with normotensive pregnancy from as soon as the first five years post-pregnancy, continuing to later life.
Several uncertainties remain, including the effect of changing demographics and pregnancy comorbidities, optimal timing for risk identification and monitoring, and what post-pregnancy interventions are effective to alter a woman's adverse cardiovascular health trajectory after HDP. International trends are for mothers to be older, more often overweight/obese, and more likely to enter pregnancy with comorbidities including hypertension and diabetes. As background cardiovascular risk profile differs in relatively young and older ages, it remains unclear if HDP's impact on long-term health differs in older versus younger age mothers. As reproductive age women are unlikely to undergo routine cardiovascular risk assessment, knowing their obstetric history might allow us to identify those at increased risk who might benefit from an early intervention. However, the impact of using obstetric history to improve risk prediction over conventional risk assessment tools remain unproven. One approach could be to monitor blood pressure levels over time, as long-term cumulative blood pressure elevation is predictive of vascular outcomes. Furthermore, existing clinical guidelines are unclear regarding optimal periods for blood pressure monitoring in women after HDP.
Women with HDP may potentially benefit from appropriate lifestyle and/or pharmacologic intervention. However, there is yet no evidence from randomised trials to demonstrate what interventions, and at what time, will be effective in reducing long-term cardiovascular risks after HDP. Determining those at highest risks to identify those who are likely to benefit from an intervention could be useful. Co-occurrence or co-existence of hypertensive disorders with other perinatal conditions (e.g., gestational diabetes), and timing of the HDP (e.g., gestational age, parity, and inter-pregnancy interval) might amplify future disease risk. Characterising and replicating these risk patterns in detail across populations and over time might give insights not just into disease mechanisms but also inform ways for improving risk prediction assessments. Whilst we focus in this review on cardiovascular disease, HDP are also associated with other chronic conditions such as diabetes. As more women with incident cardiovascular disease already present in hospitals with comorbidities, the role of pregnancy-related conditions in lifelong multimorbidity requires further investigation.
We welcome investigators to contribute their perspectives on these issues, with the view to highlighting existing evidence, knowledge gaps and future research directions. Systematic reviews and evidence-based insights would be informative in this research area. As most studies tend to involve populations in high-income countries, we would particularly welcome contributions that provide perspectives for populations from low-to-middle-income countries.
