Pregnancy Is a Screening Test for Later Life Cardiovascular Disease: Now What? Research Recommendations

Abstract

Several months ago, we wrote a commentary describing pregnancy as a screening test for later life cardiovascular diseases in mothers (Roberts & Hubel, 2010). We emphasized the wellestablished relationship of preeclampsia and gestational diabetes with later life cardiovascular disease and carbohydrate intolerance, respectively. We also pointed out the less wellestablished relationships of preterm birth, other pregnancy disorders associated with abnormal placental implantation, and even pregnancy itself with later life heart disease. We further considered the purported protective effect of breastfeeding to reduce cardiovascular disease. In the presentation, we complained that the 2007 American Heart Association’s “Evidence Based Guidelines for Cardiovascular Disease Prevention in Women” (Mosca et al., 2007) did not include a pregnancy history as a part of the evaluation of cardiovascular risk for women. We are happy to point out that the new 2011 guidelines from the American Heart Association do include a recommendation to obtain a pregnancy history and also consider both preeclampsia and gestational diabetes as risk factors for later life maternal cardiovascular disease (Mosca et al., 2011). The question that now arises is how are we to use this information? For gestational diabetes, we need to determine themost cost-effective follow-up to at least identify and perhaps prevent diabetes in later life. For preeclampsia (and by extension other relevant pregnancy disorders), the answer is not at all obvious. Once the pregnancy history of preeclampsia is determined, what is next? Little information is available to guide actions for clinicians.What testing shouldbedone?When should this be done? Is there information to justify testing women with a history of