Abstract
Pregnancy causes significant metabolic and hemodynamic changes in a woman’s physiology to allow for fetal growth. The inability to adapt to these changes might result in the development of hypertensive disorders of pregnancy (hypertension, preeclampsia or eclampsia), gestational diabetes and preterm birth. Contrary to previous beliefs these complications are not limited to the pregnancy period and may leave permanent vascular and metabolic damage. There is in addition, a direct association between these disorders and increased risk of future cardiovascular disease (CVD, including hypertension, ischemic heart disease, heart failure and stroke) and diabetes mellitus. Despite abundant evidence of this association, women who present with these complications of pregnancy do not receive adequate postpartum follow up and counseling regarding their increased risk of future CVD. The postpartum period in these women represents a unique opportunity to intervene with lifestyle modifications designed to reduce the development of premature cardiovascular complications. In some cases it allows early diagnosis and treatment of chronic hypertension or diabetes mellitus. The awareness of this relationship is growing in the medical community, especially among obstetricians and primary care physicians, who play a pivotal role in detecting these complications and assuring appropriate follow up.
Highlights
Heart disease is the number one cause of death in women older than 65 in the United States across all races and ethnicities
A recently published study showed that women with previous Gestational diabetes mellitus (GDM) have higher carotid intima media thickness, abnormal endothelial dysfunction and increased epicardial fat thickness, indicating their higher risk for cardiovascular disease, beyond their predisposition to future diabetes [99]
Pre-eclampsia occurs in 3% to 5% of all pregnancies, comparable to the prevalence of diabetes mellitus at reproductive age, a well-accepted risk marker for cardiovascular disease
Summary
Heart disease is the number one cause of death in women older than 65 in the United States across all races and ethnicities. More recently it has become apparent that there are gender and sex differences in the pathophysiology, clinical presentation and response to treatment of CVD These differences between women and men highlight the need to study sex-specific cardiovascular risk factors, such as hormonal variations and pregnancy-related disorders. Continuous efforts have to be directed toward timely recognition and intervention of CVD in women, and education about signs and symptoms of cardiovascular disease Hypertension is the most common, [3] and can occur as gestational hypertension, pre-eclampsia, chronic hypertension, or pre-eclampsia superimposed on chronic hypertension Women who develop these complications during pregnancy have a greater chance to develop cardiovascular disease later in life [4]. We focus on the current data regarding the association between these pregnancy disorders and future maternal cardiovascular and metabolic risk
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