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Placental syndromes increase women's short-term risk for cardiovascular diseases

Cardiovascular disease risk is even higher when placental syndromes are combined with poor pregnancy outcomes

Ingrid Torjesen

Wednesday, 27 July 2016

The short-term risk of developing cardiovascular disease following a first pregnancy is higher for women experiencing placental syndromes and a preterm birth or an infant born smaller than the usual size, a study* published in the American Journal of Obstetrics and Gynecology shows.

The researchers followed 302,686 Florida women and girls, ages 15 to 49, with no history of cardiovascular disease before their first documented delivery. Maternal placental syndromes were defined as gestational hypertension, preeclampsia, eclampsia, and placental abruption or infarction. Cardiovascular disease was defined as a diagnosis of coronary heart disease, cerebrovascular disease, peripheral artery disease or congestive heart failure, or a cardiac or peripheral artery revascularisation at least 90 days after the delivery discharge date.

After adjusting for sociodemographic, clinical and behavioural factors, the researchers found that women with any placental syndrome had a 19% higher risk of developing cardiovascular disease within five years of their first pregnancy than women without placental syndrome. When placental syndrome was combined with poor foetal outcomes - either preterm birth or small for gestational age, or both - the risk of cardiovascular disease upon short-term follow-up increased to 45%.

Lead author Mary Ashley Cain, MD, assistant professor in the Department of Obstetrics and Gynecology, USF Health Morsani College of Medicine, said: "Our study further supports the need for improved interconception care to identify and manage maternal high blood pressure, unhealthy weight and other cardiovascular risk factors before the next pregnancy. Early lifestyle modifications, treatment with appropriate medications and routine follow-up may improve the cardiovascular profile of these patients and help prevent or reduce future poor pregnancy outcomes."

Other epidemiological studies have shown associations between cardiovascular disease and placental syndromes, however, most have followed women with placental syndrome for long-term risk of adverse cardiovascular outcomes - up to 15 years after giving birth. This study focused on the short-term risk of developing cardiovascular disease - within five years of a first pregnancy – when disease arising would be more likely to affect any future pregnancies.

Dr Cain said: "We don't know whether existing (asymptomatic) baseline cardiovascular disease is unmasked by placental syndromes in some pregnant woman, or if something about the placental syndromes triggers damage to mothers' blood vessels that can lead to cardiovascular disease."

* Cain MA, et al. Pregnancy as a window to future health: maternal placental syndromes and short-term cardiovascular outcomes. Am J Obstet Gynecol, 2016. DOI: 10.1016/j.ajog.2016.05.047

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