Long term cardiovascular outcomes for mother and child

Abstract

Preeclampsia is well established as one of the leading causes of maternal and fetal mortality and morbidity. Furthermore, it is now clear that women who have had preeclampsia have an increased risk of cardiovascular events over the next 10-15 years. Indeed, preeclampsia is associated with a fourfold increased risk of hypertension and double the risk of fatal and non fatal ischaemic heart disease and stroke. More recently, it has been emerging that offspring born to preeclampsia are also more likely to have a higher blood pressure from the childhood and stroke in the later life. Furthermore, the risk to mother and offspring is greatest when preeclampsia is diagnosed at an earlier gestation, suggesting a more severe form of preeclampsia. As the long term cardiovascular risk to both mother and child is known from delivery there is increasing interest in key phenotypic variations that are identifiable in mothers and children during the years between the episode of preeclampsia and the emergence of established cardiovascular disease. These might help explain the link between the two conditions, provide a means to identify subjects at greatest risk of later cardiovascular disease and establish intermediate endpoints for future preventative interventions. A range of studies from research groups around the world are beginning to unravel the links between preeclampsia and long term variations in cardiac and vascular structure and function, as well as persistent biological differences in both the mother and children. This increased understanding allows both better characterisation of long term cardiovascular outcomes and better identification of optimal approaches to improve long term outcomes.