113 Preeclampsia and prevention of cardiovascular disease – What do the national guidelines recommend?

Abstract

Introduction Many studies report that women suffering from preeclampsia have an increased risk of developing hypertension and cardiovascular disease (CVD) later in life. However, due to incomplete understanding of the preeclampsia CVD association, no single CVD prevention strategy is recommended for previously preeclamptic women. Should all women be informed and thereby be classified as at risk? Or should the recommendations be more selective or await more evidence? How are the existing evidence interpreted internationally and which clinical recommendations do different national guidelines offer previously preeclamptic women today? Objectives This study aims to compare the clinical recommendations of different national guidelines on prevention of later in life hypertension and CVD in previously preeclamptic women. Methods Guidelines developed by the National Associations of Gynecologists and Obstetricians in eight different countries were compared. Results The definition of preeclampsia and especially severe preeclampsia differ between the countries. Two of the guidelines only recommend informing the woman and their general practitioner about the risk of hypertension later in life. On the contrary, the remaining six guidelines recommend informing about the increased CVD risk later in life. At the same time, these six guidelines also recommend encouraging previously preeclamptic women to pursue a healthy lifestyle. The recommendations vary substantially from no follow-up to follow-up at the postpartum period or at the age of 50. Additionally, recommendations regarding the content and frequency of follow-up also show great variations. Conclusion The definition of preeclampsia differs between countries making CVD prevention strategies difficult to compare. Furthermore, clinical recommendations of the eight examined national guidelines show substantial variation and these will be presented at the conference. This variation clearly reflects lack of evidence, but also stress the need of international debate on post-preeclampsia CVD prevention strategy.