Optimising Cardiometabolic Risk Factors in Pregnancy: A Review of Risk Prediction Models Targeting Gestational Diabetes and Hypertensive Disorders.

Eleanor P Thong,Drishti P Ghelani,Kaylee Slater,Pamada Manoleehakul,Cheryce L Harrison,Lisa Moran,Rachael Taylor,Anika Yesmin,Helena J Teede,Clare Collins,Siew S Lim,Melinda Hutchesson,Joanne Enticott

doi:10.3390/jcdd9020055

Abstract

Cardiovascular disease, especially coronary heart disease and cerebrovascular disease, is a leading cause of mortality and morbidity in women globally. The development of cardiometabolic conditions in pregnancy, such as gestational diabetes mellitus and hypertensive disorders of pregnancy, portend an increased risk of future cardiovascular disease in women. Pregnancy therefore represents a unique opportunity to detect and manage risk factors, prior to the development of cardiovascular sequelae. Risk prediction models for gestational diabetes mellitus and hypertensive disorders of pregnancy can help identify at-risk women in early pregnancy, allowing timely intervention to mitigate both short- and long-term adverse outcomes. In this narrative review, we outline the shared pathophysiological pathways for gestational diabetes mellitus and hypertensive disorders of pregnancy, summarise contemporary risk prediction models and candidate predictors for these conditions, and discuss the utility of these models in clinical application.

Highlights

Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia; School of Health Sciences, College of Health, Medicine and Wellbeing, and Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia; Abstract: Cardiovascular disease, especially coronary heart disease and cerebrovascular disease, is a leading cause of mortality and morbidity in women globally
We identify shared candidate predictors for both gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP), which can help build on established models and inform the development of a novel prediction model for composite cardiometabolic complications in pregnancy
A recent systematic review of PE prediction models showed that up to 73% of preeclampsia cases could potentially be detected using a model that included serum markers such as PIGF, sFlt- and the mean arterial pressure (MAP) at 35–37 weeks’ gestation, compared to 35% with a set of maternal characteristics assessed between 9- and 13-weeks’ gestation [61]

Summary

Introduction

Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia; School of Health Sciences, College of Health, Medicine and Wellbeing, and Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia; Abstract: Cardiovascular disease, especially coronary heart disease and cerebrovascular disease, is a leading cause of mortality and morbidity in women globally. The development of cardiometabolic conditions in pregnancy, such as gestational diabetes mellitus and hypertensive disorders of pregnancy, portend an increased risk of future cardiovascular disease in women. Risk prediction models for gestational diabetes mellitus and hypertensive disorders of pregnancy can help identify at-risk women in early pregnancy, allowing timely intervention to mitigate both short- and long-term adverse outcomes. Beyond the traditional risk factors for CVD, including diabetes mellitus and hypertension, reproductive factors such as adverse pregnancy outcomes are increasingly associated with long-term cardiovascular health [3]. The unmasking of metabolic disorders, such as gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP), in women with pre-existing vascular dysfunction [3], has key implications for the development of future cardiometabolic disease [4]. Women with a history of PE have double the risk for future CVD [12], while women with hypertensive pregnancies have a two- to eight-fold greater risk of developing chronic hypertension, compared to those with normotensive pregnancies [13]

Methods

Findings

Discussion

Conclusion