Abstract
Preeclampsia (PE) is associated with an increased risk of cardiovascular disease (CVD) in later life. Postpartum cardiovascular risk screening could identify patients who would benefit most from early intervention and lifestyle modification. However, there are no readily available methods to identify these high-risk women. We propose that placental lesions may be useful in this regard. Here, we determine the association between placental lesions and lifetime CVD risk assessed 6 months following PE. Placentas from 85 PE women were evaluated for histopathological lesions. At 6 months postpartum, a lifetime cardiovascular risk score was calculated. Placental lesions were compared between CVD risk groups and the association was assessed using odds ratios. Multivariable logistic regression was used to develop prediction models for CVD risk with placental pathology. Placentas from high-risk women had more severe lesions of maternal vascular malperfusion (MVM) and resulted in a 3-fold increased risk of screening as high-risk for CVD (OR 3.10 (1.20–7.92)) compared to women without these lesions. MVM lesion severity was moderately predictive of high-risk screening (AUC 0.63 (0.51, 0.75); sensitivity 71.8% (54.6, 84.4); specificity 54.7% (41.5, 67.3)). When clinical parameters were added, the model’s predictive performance improved (AUC 0.73 (0.62, 0.84); sensitivity 78.4% (65.4, 87.5); specificity 51.6% (34.8, 68.0)). The results suggest that placenta pathology may provide a unique modality to identify women for cardiovascular screening.
Highlights
Preeclampsia (PE) is a life-threatening hypertensive disorder of pregnancy, affecting5–7% of pregnancies worldwide [1]
We observed an increase in placental histopathological lesions in women who screened high risk for lifetime cardiovascular disease (CVD) at 6 months postpartum following a PE pregnancy
High-risk women had more severe lesions of maternal vascular malperfusion (MVM), the placental pathology traditionally associated with PE
Summary
Preeclampsia (PE) is a life-threatening hypertensive disorder of pregnancy, affecting. PE is a significant risk indicator for cardiovascular disease (CVD) in later life. Women diagnosed with PE have a ~4-fold increased risk of hypertension and a ~2-fold increased risk of ischemic heart disease and stroke compared to women with uncomplicated pregnancies [2–5]. Evidence suggests that women who develop severe PE during pregnancy are at the highest risk of these outcomes [4,6–8]. Studies show that the onset of CVD and CVD-related death occur at much younger ages than the general female population [6–9]. The link(s) between PE and cardiovascular risk are not fully understood, but PE may indicate the presence of underlying, often undiagnosed, cardiovascular risk factors (CVRs) [10,11]
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