Abstract
Pre-eclampsia is a hypertensive disorder of pregnancy that is associated with elevated maternal risk for cardiovascular disease. The aims of this study were to determine the effect of normal pregnancy on postpartum parameters of the electrocardiogram, and furthermore to determine how a history of pre-eclampsia may affect these parameters. Ten-minute high-resolution (1000 Hz) orthogonal Holter electrocardiogram (ECG) recordings were used to measure heart rate variability (HRV). Signal-averaged P-wave and QRS complex durations were determined. Participants included non-pregnant controls, normotensive parous controls and women with a recent history of PE. While reductions in HRV induced by uncomplicated pregnancy returned to non-pregnant levels by 6–8 months postpartum HRV remained reduced in women with a history of PE compared to control groups. In addition, P-Wave and QRS complex durations were prolonged in PE subjects at 6–8 months postpartum compared to control groups. Only QRS duration was independent of differences in blood pressure. These results suggest increased sympathetic cardiac activity, and delayed myocardial conduction in women after PE; alterations consistent with cardiac remodeling and increased risk for arrhythmia. In examining the association between PE and cardiovascular disease, identification of ECG abnormalities soon after pregnancy in women with a history of PE highlights a unique opportunity for early identification and screening in this population before other risk factors become apparent.
Highlights
Pre-eclampsia (PE) is a common hypertensive disorder of pregnancy that affects 6–10% of pregnancies worldwide
While it remains uncertain whether PE exacerbates previously unrecognized cardiovascular risk factors, or if cardiovascular risk associated with PE is the direct result of the manifestation of the disorder itself, developing an understanding of the early postpartum implications of PE on the maternal cardiovascular system remains important if targeted prevention and screening are to be successful
Using short-term ECG recordings we have demonstrated that women with a recent history of PE exhibit reduced time domain parameters of heart rate variability (HRV) compared to never-pregnant and time
Summary
Pre-eclampsia (PE) is a common hypertensive disorder of pregnancy that affects 6–10% of pregnancies worldwide. A recent evidence-based review has called for the implementation of cardiovascular risk screening clinics designed to target postpartum women with a history of indicated pregnancy complications [3]. While it remains uncertain whether PE exacerbates previously unrecognized cardiovascular risk factors, or if cardiovascular risk associated with PE is the direct result of the manifestation of the disorder itself, developing an understanding of the early postpartum implications of PE on the maternal cardiovascular system remains important if targeted prevention and screening are to be successful
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