Increased microvascular vasodilation and cardiovascular risk following a pre-eclamptic pregnancy.

Abstract

Women who develop pre‐eclampsia are at high‐risk for premature cardiovascular disease and death. The aim of this study was to assess microvascular function and cardiovascular risk in the early postpartum period for women who did/did not have a pregnancy complicated by pre‐eclampsia. Peripheral microvascular function was assessed in women in the third trimester of uncomplicated pregnancies, with re‐evaluation at 2 and 6 months postpartum. The effect of pre‐eclampsia on postpartum microvascular function was assessed 2 and 6 months after delivery. Never‐pregnant, naturally cycling women served for comparison. Cutaneous microvascular reactivity to acetylcholine and sodium nitroprusside, delivered locally by iontophoresis, was measured by laser Doppler flowmetry. 30‐year and lifetime risk estimates for cardiovascular disease were established. Acetylcholine‐mediated vasodilation was enhanced by normotensive pregnancy, and declined to nonpregnant levels by 6 months postpartum. Acetylcholine‐mediated vasodilation remained high in pre‐eclamptic subjects from 2 to 6 months postpartum compared to normotensive and never‐pregnant controls. Pre‐eclamptic subjects exhibited elevated 30‐year and lifetime risk at 6 months postpartum. This study provides in vivo evidence of microvascular and cardiovascular risk implications of pre‐eclampsia as early as 6 months postpartum, and suggests that the development of pre‐eclampsia may be used to identify women at risk and eligible for risk screening and intervention.