Prior Preeclampsia Research Articles

Needs and preferences of women with prior severe preeclampsia regarding app-based cardiovascular health promotion

BackgroundWomen with prior severe preeclampsia are at an increased risk for cardiovascular diseases later in life compared to women who had a normotensive pregnancy. The objective of this study was to assess their needs and preferences regarding app-based cardiovascular health promotion.MethodsPatients (n = 35) of the Follow-Up PreEClampsia Outpatient Clinic (FUPEC), Erasmus MC, the Netherlands, participated in an anonymous online survey. The main outcomes under study were women’s needs for health behavior promotion, and their preferences with respect to intervention delivery. Descriptive statistics were used to evaluate needs, and thematic analysis was used to analyze preferences.ResultsWomen’s primary need for health behavior promotion pertained to their fat and sugar intake and physical activity; for some, to their mental health (practices), fruit and vegetable intake, salt intake, and water intake; and for a few, to their alcohol and tobacco use. Most women preferred an app-based intervention to include, in descending order: the tracking of health-related metrics, an interactive platform, the use of behavior change strategies, the provision of information, and personalization.ConclusionCardiovascular health promotion targeting women with prior severe preeclampsia should feel relevant to its audience. App-based interventions are likely to be well received if they target fat and sugar intake and physical activity. These interventions should preferably track health-related metrics, be interactive, contain behavior change strategies, provide information, and be personalized. Adopting these findings during intervention design could potentially increase uptake, behavior change, and behavior change maintenance in this population.

Arterial health abnormalities in women with pre-eclampsia: contributing role of central obesity

Abstract Introduction Women who suffer from pre-eclampsia (PE) are at higher risk of developing cardiovascular disease (CVD) later in life. This risk can be explained in part by the observation of worse arterial health in these women, with PE either acting as a cause or harbinger of a worse baseline risk profile. Central obesity (CO) is an established risk factor for PE, while it also adversely affects cardiovascular risk. However, whether CO contributes to further worsening of arterial hemodynamics in pre-eclamptic women remains unclear. Purpose To evaluate the effect of CO combined with previous PE on women's arterial hemodynamics. Methods We studied 40 women with history of PE <6 years and 40 age-matched women with previous normotensive pregnancy (controls) in the same timeframe. We estimated aortic stiffness, central blood pressure, and measures of steady and pulsatile arterial load with validated techniques combining applanation tonometry and transthoracic echocardiography. CO was defined as a waist-to-hip ratio (WHR) ≥0.85 according to WHO criteria for women. Differences in arterial hemodynamics across the 3 groups [PE with CO (PE-CO), PE without CO (PE-noCO), controls] were assessed with One-Way ANOVA, and in multivariable linear regression models adjusted for age, hypertension, diabetes, serum creatinine, and parity. Results Twenty-six (65%) of the PE women had CO, compared to 18 (45%) of controls (p=0.07). Patient characteristics are described in the Table. In unadjusted analyses, PE-CO women had higher central systolic blood pressure as compared to PE-noCO and controls respectively (117±21 vs 100±12 and 95±9 mmHg, p<0.01), as well as higher carotid-femoral pulse wave velocity (6.58±0.97 vs 5.95±1.01 and 5.68±0.75 m/s, p<0.01) and forward pressure wave amplitude (42.32±11.16 vs 33.31±6.85 and 37.12±8.70 mmHg, p=0.01), with lower proximal aortic compliance (8.56±3.19 vs 11.47±0.95 and 11.06±3.59x10–6 cm4/dyne, p=0.01) and total arterial compliance (1.38±0.42 vs 1.74±0.53 and 1.71±0.45 mL/mmHg, p=0.01). (Figure) After adjustment for potential confounders in multivariable linear regression, PE-CO women had higher central systolic blood pressure (mean difference [MD] = 10±2.5 mmHg, p<0.01), carotid-femoral pulse wave velocity (MD = 0.42±0.15 m/s, p<0.01) and lower proximal aortic compliance (MD = −1.13±0.63x10–6 cm4/dyne, p=0.04) as compared to controls, while hemodynamics of PE-noCO did not significantly differ from controls. Conclusion We demonstrate for the first time the contribution of CO in adversely affecting arterial health and central hemodynamics in women with PE. Conversely, women with prior PE who did not have CO had similar arterial hemodynamics as compared to women with normotensive pregnancies. Understanding that worse arterial stiffness and hemodynamics are linked to future CVD, our results suggest that PE-CO may represent a higher risk subgroup who may be candidates for early, targeted efforts at primary prevention of CVD. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Heart Team Grant from the University of Ottawa Heart Institute Foundation

Maternal Outcomes in Women with Peripartum Cardiomyopathy versus Age and Race-Matched Peers in an Urban US Community.

Peripartum cardiomyopathy (PPCM) is idiopathic systolic congestive heart failure around pregnancy. Comparisons with matched controls are lacking. We investigated maternal characteristics and outcomes up to 12 months in a cohort admitted to Montefiore Health System in Bronx, New York 1999–2015 (n = 53 cases and n = 92 age and race-matched controls, >80% Black or Hispanic/Latina). Compared to peers, women with PPCM had more chronic hypertension (24.5% vs. 8.8%, p = 0.001), prior gestational hypertension (20.8% vs. 5.4%, p = 0.001), prior preeclampsia (17.0% vs. 3.3%, p = 0.001), familial dilated cardiomyopathy (5.7% vs. 0.0%, p = 0.04), smoking (15.1% vs. 2.2%, p = 0.001), lower summary socioeconomic scores (−4.12 (IQR −6.81, −2.13) vs. −1.62 (IQR −4.20, −0.74), p < 0.001), public insurance (67.9% vs. 29.3% p = 0.001), and frequent depressive symptoms. Women with PPCM were often admitted antepartum (34.0% vs. 18.5%, p = 0.001) and underwent Cesarean section (65.4% vs. 30.4%, p = 0.001), but had less preterm labor (27.3% vs. 51.1%, p = 0.001). Women were rarely treated with bromocriptine (3.8%), frequently underwent left ventricular assist device placement (9.4% and n = 2 with menorrhagia requiring transfusion and progesterone) or heart transplantation (3.8%), but there were no in-hospital deaths. In sum, women with PPCM had worse socioeconomic disadvantage and baseline health than matched peers. Programs addressing social determinants of health may be important for women at high risk of PPCM.

SFlt1‐Induced Preeclampsia Enhances Cardiovascular Response to Post Partum Hypertensive Stimuli via Smooth Muscle Mineralocorticoid Receptor

BackgroundPreeclampsia (PE), a syndrome of high blood pressure (BP) and renal damage in late pregnancy, is associated with increased soluble VEGF receptor (sFlt1) and survivors have increased risk of future hypertension and cardiovascular disease.HypothesisSince smooth muscle cell mineralocorticoid receptor (SMC‐MR) can be activated by hypertensive stimuli, we hypothesized that high sFlt1 exposure during pregnancy may induce a post‐partum state of enhanced vascular sensitivity via SMC‐MR activation.Methods/ResultsA PE model was induced by transient viral expression of sFlt1 in pregnant C57Bl6 mice. Elevated serum sFlt1, BP and glomerular endotheliosis was confirmed which all resolve post‐partum. In a small cohort of women with prior PE, we confirm salt sensitivity of BP. Thus, postpartum mice were implanted with telemetric BP monitors and exposed to repeated hypertensive stimuli (high salt and subsequent AngII). Mice with prior PE had a significantly increased BP response to hypertensive stimuli. Microvascular arteries from mice after PE and hypertensive stimuli had enhanced ex vivomyogenic tone and AngII vasoconstriction. To test the direct impact of sFlt1 on SMC‐MR function, cultured SMC (Pac1) were transiently exposed to sFlt1 (24 hours on then off) to mimic the post‐PE state. SMC‐MR transcriptional activity in response to aldosterone and AngII were significantly increased after sFlt1 exposure as measured by luciferase reporter assay. Target gene expression was also enhanced after sFlt1 exposure. Finally, the role of SMC‐MR in the post‐PE phenotype was tested in vivo by PE induction in SMC‐MR‐KO vs MR‐intact littermates. Post partum, SMC‐MR‐KO mice were protected from the PE‐induced increase in aortic stiffness, microvascular myogenic tone and AngII vasoconstriction.ConclusionsFlt1‐induced PE produces a state of enhanced sensitivity to stimuli that may be mediated by increased activation of SMC‐MR. These data support the use of MR antagonists to mitigate the increased risk of cardiovascular disease in women exposed to PE.

Perceived determinants of physical activity among women with prior severe preeclampsia: a qualitative assessment

BackgroundThe objective of this study was to (1) qualitatively identify the perceived determinants of physical activity among women who have experienced severe preeclampsia, and (2) examine whether these determinants are consistent with the overarching processes outlined in the integrated behavior change (IBC) model, a novel model that describes physical activity as being a result of motivational, volitional, and automatic processes.MethodsPatients (n = 35) of the Follow-Up PreEClampsia (FUPEC) Outpatient Clinic, Erasmus MC, the Netherlands, participated in an anonymous online survey. The main outcomes under study were their perceived determinants of physical activity. Responses were analyzed using thematic analysis.ResultsThirteen themes emerged from the analysis. Six themes corresponded with motivational processes (future health, perceived ability, attitude, future reward or regret, physical appearance, and doing it for others), two with volitional processes (scheduling and planning), and two with automatic processes (affect and stress). Three themes were classified as environmental factors (time constraint, social support, and physical environment).ConclusionsA range of facilitating and hindering factors were described by women with prior severe preeclampsia as the determinants of their physical activity. These factors corresponded well with the overarching motivational, volitional, and automatic processes described in the IBC model. In addition, motivational and environmental factors beyond the IBC model were described. Addressing these perceived determinants could enhance the efficacy of physical activity interventions in this population.Tweetable abstract: Motivational, volitional, automatic, and environmental factors drive physical activity in women with prior severe preeclampsia.

Increased carotid artery stiffness after preeclampsia in a cross-sectional study of postpartum women.

Preeclampsia (PE) is a hypertensive obstetrical complication associated with increased cardiovascular disease risk. Carotid artery functional assessments allow for identification of subclinical vascular dysfunction. This cross‐sectional study measured carotid artery functional indices in healthy women with a recent pregnancy complicated by PE, versus women with a prior uncomplicated pregnancy. Women with a history of PE (N = 30) or an uncomplicated pregnancy (N = 30), were recruited between 6 months and 5 years postpartum. Left and right carotid artery ultrasound measured carotid intima media thickness, plaque burden, peak systolic velocity, end diastolic flow velocity and carotid far‐wall circumferential strain (FWCS). Carotid FWCS is inversely related to vessel stiffness, where a decrease in FWCS indicates increased vessel stiffness. Right‐side FWCS did not differ between women with a history of PE versus normotensive pregnancy. Left carotid artery FWCS was lower in formerly preeclamptic women after adjustment for diameter, pulse pressure, and heart rate compared to women following an uncomplicated pregnancy (3.35 ± 1.08 × 10−3 vs. 4.46 ± 1.40 × 10−3; p = 0.003). Those with prior severe PE had the greatest decrease in FWCS adjusted to diameter, pulse pressure, and heart rate compared to healthy controls (p = 0.02). Adjusted FWCS and total serum cholesterol were independent indicators of PE history when present in a logistic regression model with confounding variables including age, body mass index, and resting blood pressure. Further investigation is needed to elucidate if FWCS can be used as a risk stratification tool for future cardiovascular disease following a pregnancy complicated by PE. A history of PE is associated with decreased left FWCS (increased left carotid artery stiffness).

Association between hypertensive disorders of pregnancy and later risk of cardiovascular outcomes

BackgroundHypertensive disorders of pregnancy are common pregnancy complications that are associated with greater cardiovascular disease risk for mothers. However, risk of cardiovascular disease subtypes associated with gestational hypertension or pre-eclampsia is unclear. The present study aims to compare the risk of cardiovascular disease outcomes for women with and without a history of gestational hypertension and pre-eclampsia using national hospital admissions data.MethodsThis was a retrospective cohort study of national medical records from all National Health Service hospitals in England. Women who had one or more singleton live births in England between 1997 and 2015 were included in the analysis. Risk of total cardiovascular disease and 19 pre-specified cardiovascular disease subtypes, including stroke, coronary heart disease, cardiomyopathy and peripheral arterial disease, was calculated separately for women with a history of gestational hypertension and pre-eclampsia compared to normotensive pregnancies.ResultsAmongst 2,359,386 first live births, there were 85,277 and 74,542 hospital admissions with a diagnosis of gestational hypertension and pre-eclampsia, respectively. During 18 years (16,309,386 person-years) of follow-up, the number and incidence of total CVD for normotensive women, women with prior gestational hypertension and women with prior pre-eclampsia were n = 8668, 57.1 (95% CI: 55.9–58.3) per 100,000 person-years; n = 521, 85.8 (78.6–93.5) per 100,000 person-years; and n = 518, 99.3 (90.9–108.2) per 100,000 person-years, respectively. Adjusted HRs (aHR) for total CVD were aHR (95% CI) = 1.45 (1.33–1.59) for women with prior gestational hypertension and aHR = 1.62 (1.48–1.78) for women with prior pre-eclampsia.Gestational hypertension was strongly associated with dilated cardiomyopathy, aHR = 2.85 (1.67–4.86), and unstable angina, aHR = 1.92 (1.33–2.77). Pre-eclampsia was strongly associated with hypertrophic cardiomyopathy, aHR = 3.27 (1.49–7.19), and acute myocardial infarction, aHR = 2.46 (1.72–3.53). Associations were broadly homogenous across cardiovascular disease subtypes and increased with a greater number of affected pregnancies.ConclusionsWomen with either previous gestational hypertension or pre-eclampsia are at greater risk of a range of cardiovascular outcomes. These women may benefit from clinical risk assessment or early interventions to mitigate their greater risk of various cardiovascular outcomes.

Maternal Cardiovascular Disease After Pre-Eclampsia and Gestational Hypertension: A Narrative Review.

Previous literature has highlighted that women who have a pregnancy affected by gestational hypertension or preeclampsia are at higher risk of cardiovascular disease (CVD) in later life. However, CVD is a composite of multiple outcomes, including coronary heart disease, heart failure, and stroke, and the risk of both CVD and hypertensive disorders of pregnancy varies by the population studied. We conducted a narrative review of the risk of cardiovascular outcomes for women with prior gestational hypertension and pre-eclampsia. Previous literature is summarized by country and ethnicity, with a higher risk of CVD and coronary heart disease observed after gestational hypertension and a higher risk of CVD, coronary heart disease and heart failure observed after pre-eclampsia in most of the populations studied. Only one study was identified in a low- or middle-income country, and the majority of studies were conducted in white or mixed ethnicity populations. We discuss potential interventions to mitigate cardiovascular risk for these women in different settings and highlight the need for a greater understanding of the epidemiology of CVD risk after gestational hypertension and pre-eclampsia outside of high-income, white populations.

Early Pregnancy Blood Pressure Trajectories and Hypertensive Disorders: Differences by Pre-pregnancy BMI and Race/Ethnicity

To determine the associations between early pregnancy blood pressure (BP) trajectory patterns and development of hypertensive disorders of pregnancy (HDP) in women without chronic hypertension (CH) or prior preeclampsia (PE), and potential effect modification by body mass index (BMI) and race/ethnicity.

Postpartum Hypertension Education Improves Patient Hypertension Knowledge

Preeclampsia (PE) and eclampsia account for more than 19% of maternal mortality in Mississippi. Recent patient, provider, and advocacy focus groups have indicated a need for increased awareness and management of postpartum (PP) cardiovascular health among women with prior PE. The aim of this study is to examine the effect of hypertension (HTN) education on the awareness and knowledge of PP cardiovascular health.

Abstract 14155: Exposure to sFlt1-Induced Preeclampsia Enhances the Future Vascular Response to Hypertensive Stimuli in Mice in a Smooth Muscle Mineralocorticoid Receptor Dependent Manner

Preeclampsia (PE), a syndrome of high blood pressure (BP) and renal damage in late pregnancy, is associated with increased soluble VEGF receptor (sFlt1) and survivors have increased risk of future hypertension with increased angiotensin II (AngII) and salt sensitivity. Since smooth muscle cell mineralocorticoid receptor (SMC-MR) can be activated by hypertensive stimuli, we hypothesized that high sFlt1 exposure during pregnancy may induce a post-partum state of enhanced vascular sensitivity via SMC-MR activation. A PE model was induced by transient viral expression of sFlt1 in pregnant C57Bl6 mice. Elevated serum sFlt1, BP and glomerular endotheliosis was confirmed which all resolve post-partum. Two months later, resistance arteries from post-PE mice show no change in vasoconstriction to AngII but with increased mRNA ratio of the pro-constrictive AngII receptor-1(ATR1) to the vasodilatory ATR2. In a small cohort of women with prior PE, we confirm salt sensitivity of BP thus, postpartum mice were implanted with telemetric BP monitors and exposed to high salt or AngII (600mg/kg/day) infusion. Mice with prior PE had a significantly increased BP response to hypertensive stimuli. Microvessels from mice after PE and hypertensive stimuli had enhanced ex vivo myogenic tone and AngII vasoconstriction. To test the direct impact of sFlt1 on SMC-MR function, cultured SMC (Pac1) were transiently exposed to sFlt1 (24 hours on then off) to mimic the post-PE state. SMC-MR transcriptional activity in response to aldosterone and AngII were significantly increased after sFlt1 exposure as measured by luciferase reporter assay. SMC-MR activation and target gene expression was also enhanced after sFlt1 exposure (including AT1R/AT2R ratio). Finally, the role of SMC-MR in the post-PE phenotype was tested in vivo by PE induction in SMC-MR-KO vs MR-intact littermates. Post partum, SMC-MR-KO mice were protected from the PE-induced increase in aortic stiffness, microvascular myogenic tone and AngII vasoconstriction. sFlt1-induced PE produces a state of enhanced sensitivity to AngII that may be mediated by increased activation of SMC-MR. These data support the use of MR antagonists to mitigate the increased risk of cardiovascular disease in women exposed to PE.

Use of a Smartphone App to Explore Potential Underuse of Prophylactic Aspirin for Preeclampsia

Preeclampsia is a leading preventable cause of maternal morbidity and mortality. Initiation of low-dose aspirin (LDASA) treatment at or before 16 weeks' gestation may prevent preeclampsia onset for patients with specific risk factors. To assess potential underuse of LDASA and reasons for underuse using data from a prenatal care smartphone app. In this prospective cohort study, English-speaking pregnant patients aged 18 years or older from the UPMC health care system received an invitation to use the MyHealthyPregnancy app at their first prenatal appointment. Use of the app was voluntary. The study took place between September 23, 2019, and August 31, 2020, as part of a quality-improvement initiative. The app offered educational information, monitoring tools, and routine screenings tailored to patient-entered gestational age and demographic and clinical characteristics. App-based questions included LDASA eligibility based on US Preventive Services Task Force criteria for preeclampsia risk and a monthly prompt about LDASA recommendations from the patient's health care practitioner. The primary outcomes were the receipt of LDASA recommendations from a practitioner and adherence to any such recommendation, as self-reported on the app. Patients' medical records were examined to cross-reference their self-reports of an LDASA recommendation. Multivariable logistic regression was used to model patient-perceived recommendation as a function of factors associated with preeclampsia. The patient cohort consisted of 2563 patient participants (2036 [79%] White; mean [SD] age, 30 [5.2] years) with 2567 pregnancies; 1882 pregnancies (73.3%) were among women with private or employer-based insurance, and 1246 (48.5%) were among nulliparous patients. At least 1 factor associated with high risk for preeclampsia was reported in 316 pregnancies (12.3%), and 2 or more factors associated with moderate risk were reported in 1051 (40.9%). Of the 1015 pregnancies for which patients answered voluntary questions about aspirin use, 124 (12.2%) met at least 1 criterion for highest risk of preeclampsia. In 57 (46.0%) of these pregnancies, the patient indicated that their practitioner recommended LDASA; after examination of the medical records, 90 pregnancies (72.6%) had evidence of an LDASA recommendation and 34 (27.4%) did not. Of the 90 pregnancies with a documented LDASA recommendation, 33 patients (36.7%) were unaware of it. Prior preeclampsia (28 weeks' gestation: odds ratio, 20.1; 95% CI, 11.0-36.9) and chronic hypertension (28 weeks' gestation: odds ratio, 17.4; 95% CI, 6.3-48.2) were the primary high-risk factors associated with recommendation of LDASA. In this cohort study, only 46.0% of prenatal care app users who met the criteria for highest preeclampsia risk reported receiving an LDASA recommendation from their practitioner, and medical records suggested that there may have been frequent miscommunication between patients and practitioners about LDASA use. Digital tools such as the MyHealthyPregnancy app might offer an opportunity to improve identification of patients at risk for preeclampsia and communication with these patients about aspirin use.

Prevalence of hypertensive disorders during pregnancy in France (2010-2018): The Nationwide CONCEPTION Study.

Hypertensive disorders of pregnancy (HDP) are one of the leading causes of maternal and fetal morbidity and mortality. We aimed to estimate the prevalence of each HDP in France and to study their associations. All pregnant women who delivered in France between 2010 and 2018 were included in a cohort and followed during their pregnancy and 6 weeks of postpartum. Each HDP occurring during the follow‐up was identified. Prevalence of each HDP and cumulative incidence by gestational age were estimated. Incidence rate ratio (IRR) and 95% confidence interval (CI) for preeclampsia among women with preexisting or gestational hypertension (GH) were estimated using Poisson regression and adjusted for age were estimated. Between 2010 and 2018, 6 302 810 deliveries were included. HDP complicated 7.4% of pregnancies. Preeclampsia and GH complicated 2.0% and 4.2% of pregnancies, respectively. Most of preeclampsia cases occurred without a prior HDP. HELLP syndrome represented 10.4% of preeclampsia cases. Compared to nulliparous pregnancies without HDP prior preeclampsia, the age‐adjusted IRR of preeclampsia was 6.2 [95% CI: 6.1‐6.4] in nulliparous pregnancies with preexisting hypertension and 2.9 [95% CI: 2.8‐3.0] in nulliparous pregnancies with GH. In France, HDP occurred in 7.4% of all pregnancies. Women with preexisting chronic hypertension are at high risk to present preeclampsia during pregnancy. Preeclampsia complicated 2.0% of pregnancies in France. Tailoring management of women according to the HDP is a major challenge to avoid complications related to these disorders.

The interval between births and the risk of recurrent preeclampsia among predominantly high risk women in urban tertiary care center

Women with a history of preeclampsia have a higher risk of recurrent preeclampsia. This study sought to ascertain the relationship between the interbirth interval and the risk of recurrent preeclampsia and difference in angiogenic markers between the two groups. Data was collected from an ongoing cohort study of women with hypertensive disorders of pregnancy (HDP) enrolled at the admission to the labor and delivery floor. From this dataset, multigravida women with a prior diagnosis of preeclampsia were identified and compared to women with no prior history of preeclampsia. Of the 375 women with HDP who were predominantly African American, 245 were multigravida and 44 (18.0%) had a prior history of preeclampsia. Women with prior preeclampsia had an earlier gestational age of delivery, higher rates of preterm delivery and a higher incidence of preeclampsia with severe features (56.8% vs 29.8%) in the index pregnancy (p-values≤0.001) than those without. The median number of years between history of preeclampsia in previous pregnancy and current pregnancy was 6years (IQR 3, 8). Among patients with a prior history of preeclampsia, the interbirth interval was not associated with severe preeclampsia (p=0.60) and there was no difference in angiogenic factors between patients with a prior history of preeclampsia compared to those without. In this study, the duration of the interbirth interval was not identified as a risk factor of developing severe preeclampsia in a subsequent pregnancy and angiogenic factors are not a reflection of maternal predisposition to recurrent preeclampsia.

Persistent hypertension after preeclampsia in a group of Cameroonians: Result of a cross-sectional study and perspectives to reduce its burden in Limited Income Countries.

Preeclampsia/eclampsia significantly increases the risk of future hypertension. Several factors may be involved in this process. The purpose of this study was to identify them in Cameroonians. We conduct a cross‐sectional study including women aged 18 to 45 years, who deliver between December 2011 and 2016, and were diagnosed and followed up for preeclampsia/eclampsia in two major obstetrical and gynecologic units in Yaoundé (Cameroon). Those with persistent high‐blood pressure after 6 months were classified as persistent hypertension (PH). Associated factors were investigated using multivariate analysis with logistic regression and presented with an adjusted odds ratio (aOR) and the 95% confidence interval. 92 participants were included, with 30 (32.6%) with PH. The independent factors associated with PH were as follows: maternal age during preeclampsia above 30 years (aOR = 6.30 [1.1; 35.4], p = .03), at least five deliveries prior preeclampsia (aOR = 1.50 [2; 6.6], p = .008), and family history of diabetes (aOR = 14.8 [2.6; 85.7], p = .003). About one in three women with preeclampsia/eclampsia will have PH. The clinician needs to pay more attention to the potential risk factors identified above. More appropriate strategies need to address the burden of this condition in the context of low resources.

28 Women with prior preeclampsia have higher rates of hypertension and persistent T helper-associated inflammation

Preeclampsia (PreE) contributes to long-term maternal cardiovascular disease risk. By 2025, it is estimated that more women than men will have hypertension (HTN), yet the mechanisms contributing to the development of HTN in women are less understood. Anti- and pro- inflammatory T helper (Th) responses are dysregulated in PreE. A persistent imbalance of these Th responses following PreE may underlie the future development of HTN in women. Therefore, the objective of this study was to determine if the immune Th changes observed during PreE persist post-partum (PP). De-identified and coded plasma samples were obtained from the Magee-Women’s Research Institute & Foundation or the University of Iowa Maternal-Fetal Tissue Bank (IRB 201808705) from women 1-3 (N=93) or 8-10 (N=58) years (yrs) following a normotensive or PreE-affected pregnancy. PP HTN was defined as having stage 1 or higher HTN as designated in the updated 2017 ACC/AHA guidelines. Th cytokine concentrations were determined via ELISAs and normalized to total protein. Average cytokine concentrations are reported in pg/g. Women with prior PreE had higher rates of HTN at 1-3 and 8-10 yrs PP (Table 1), compared to women with a normotensive pregnancy. At 1-3 yrs PP, concentrations of anti-inflammatory cytokines IL-4, IL-10, and TGFb were reduced in women with a prior PreE pregnancy. At 8-10 yrs PP, pro-inflammatory IL-6 and TNFa were significantly increased in women with prior PreE compared to women with a normotensive pregnancy (Table 2). Women with a prior PreE pregnancy had a higher incidence of HTN early (1-3 yrs) and late (8-10 yrs) PP compared to women with a normotensive pregnancy. Following PreE, anti-inflammatory Th cytokines continue to be suppressed in the early PP period, creating an inflammatory milieu. By 8-10 yrs PP, this inflammatory environment is further exacerbated by elevated levels of IL-6 and TNFa. This Th-associated inflammation is associated with increased rates of HTN and thus, may underlie the future development of HTN in women with a history of PreE.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Microvascular outcomes of a pregnancy complicated by preeclampsia

Preeclampsia (PE) in pregnancy is associated with future cardiovascular disease through poorly understood mechanisms. Endothelial dysfunction persists in women following PE in pregnancy. We hypothesized that microvascular endothelial dysfunction associated with PE may be a postpartum mechanism of incipient cardiovascular disease. The purpose of this study was to examine the association of prior PE to postpartum changes in maternal microvascular endothelial function.

Maternal Cardiovascular Function Following a Pregnancy Complicated by Preeclampsia.

Preeclampsia is a hypertensive pregnancy complication with an unknown etiology and high maternal burden worldwide. Burgeoning research has linked preeclampsia to adverse maternal health outcomes remote from pregnancy; however, the intermediary mechanisms responsible for this association have not been sufficiently established. In the present narrative review, we summarize leading evidence of structural and functional cardiovascular changes associated with prior preeclampsia, and how these changes may be linked to future maternal disease. KEY POINTS: · Prior preeclampsia is associated with subclinical structural and functional vascular changes remote from pregnancy.. · Maternal cardiac adaptations to preeclampsia may have long-term implications on cardiovascular health.. · Clinicians have an opportunity to minimize maternal disease risk following preeclampsia..

Recognizing Cardiovascular Risk After Preeclampsia: The P4 Study.

BackgroundThere is increased risk of hypertension, early cardiovascular disease, and premature mortality in women who have had preeclampsia. This study was undertaken to determine the upper limit of normal blood pressure (BP) 6 months postpartum and the frequency of women with prior preeclampsia who had BP above these limits, as part of the P4 (Post‐Partum Physiology, Psychology and Pediatric) follow‐up study.Methods and ResultsBP was measured by sphygmomanometer, 24‐hour ambulatory BP monitoring, and non‐invasive central BP at 6 months postpartum in 302 women who had normotensive pregnancy and 90 who had preeclampsia. The upper limit of normal BP (mean+2 SD) for women with normotensive pregnancy was 122/79 mm Hg for routine BP, 115/81 mm Hg for central BP, and 121/78 mm Hg for 24‐hour ambulatory BP monitoring. Traditional normal values detected only 3% of women who had preeclampsia as having high BP 6 months postpartum whereas these new values detected between 13% and 19%. Women with preeclampsia had greater body mass index (27.8 versus 25.0, P<0.001) and left ventricular wall thickness but similar augmentation index. They also had lower high‐density lipoprotein (59±15 versus 65±16 mg/dL, P=0.002), higher triglycerides (77±51 versus 61±35 mg/dL, P=0.005), and higher homeostatic model assessment score (2.1±1.8 versus 1.3±1.9, P<0.001).ConclusionsClinicians wishing to detect high BP in these women should be aware of the lower than usual upper limit of normal for this young cohort and where possible should use 24‐hour ambulatory BP monitoring to detect these changes. This may define a subgroup of women who had preeclampsia for whom targeted BP lowering therapy would be successful.RegistrationURL: https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365295&isReview=true; Unique identifier: ACTRN12613001260718.

Improving Utilization of Aspirin for Prevention of Preeclampsia in a High-Risk Urban Cohort: A Prospective Cohort Study.

This study aimed to evaluate the utilization of aspirin for preeclampsia prevention before and after implementation of a screening tool during nuchal translucency (NT) ultrasound. One-year prospective cohort study of patients at high risk for preeclampsia after the implementation of a screening tool (postscreen) administered to all patients at check in for NT (11-13 weeks) ultrasound. Prospective cohort was compared with one-year retrospective cohort (prescreen) the year prior (2017). All patients who presented for NT ultrasound in both cohorts were evaluated for the presence of one or more risk factor for preeclampsia with screening tool collected prospectively and chart review retrospectively. Provider recommendation for aspirin determined by documentation in prenatal record. Primary outcome was rate of provider recommendation for aspirin pre versus post screening tool, compared by Chi-square test and adjusted for potential confounders with multiple regression analysis. Pre- (n = 156) and postscreen (n = 136) cohorts were similar except for race and multifetal gestation. Prescreen, rate of provider recommendation for aspirin was 74%. Of those with prior preeclampsia, 96% were recommended aspirin, compared with 64% of patients with other risk factors (p < 0.001). Postscreen, provider recommendation of aspirin improved to 95% (p < 0.001). Rate of preeclampsia/gestational hypertension were similar between cohorts; however, there was a reduced adjusted risk in overall preterm birth <37 weeks (adjusted odds ratio [aOR] = 0.50 [0.25-0.99]) and preterm birth <34 weeks (aOR = 0.33 [0.13-0.88]) postscreening tool implementation. Prior to implementation of a simple screening questionnaire, approximately 25% of high risk patients did not receive the recommendation of aspirin for preeclampsia prevention. High-risk patients who lack a history of preeclampsia were less likely to be advised of aspirin prophylaxis. Use of a simple universal screening tool at time of NT ultrasound significantly improved utilization of aspirin for preeclampsia prevention and may improve patient outcomes. · Despite recommendations, aspirin use for preeclampsia prevention is suboptimal.. · High-risk patients who lack a history preeclampsia were less likely to be advised of aspirin use.. · A simple universal screening tool can significantly improve aspirin utilization..