Pre-eclampsia and maternal placental syndromes: an indicator of a predisposition or cause of long-term cardiovascular disease?
- 1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
- 2Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
- Correspondence to Dr Vesna D Garovic, Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; garovic.vesna{at}mayo.edu
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Contributors All authors have contributed to writing this editorial.
- Hypertension
- pregnancy induced
- placenta diseases
- heart failure
- arrhythmias
- cardiac, coronary physiology, valvular disease, interventional cardiology, cardiac function, obstetrics, peripheral vascular disease
Maternal placental syndromes (MPS) occur as a consequence of abnormal placental vessel formation, and refer to hypertensive pregnancy disorders (HPDs) and related placental abnormalities, such as placental abruption and infarction.1 In the affected pregnancies, adverse pregnancy outcomes, including preterm delivery, foetal growth retardation and intrauterine foetal demise, are common. HPDs complicate about 5–10% of pregnancies worldwide2 and cover a spectrum of conditions. Most notable among these is preeclampsia, a multisystem pregnancy-specific disorder clinically characterised by hypertension and proteinuria, and which remains a leading cause of foetal and maternal morbidity and mortality. Evidence suggests that preeclampsia is associated with the release of antiangiogenic factors by an ischaemic placenta, which, in turn, may lead to maternal endothelial dysfunction.3 4
In 1927, Corwin and Herrick reported an association between ‘hypertensive toxemia of pregnancy’, as pre-eclampsia was once called, and chronic cardiovascular disease.5 Since then, there have been multiple epidemiological studies that confirm these authors' observation. HPDs have been associated with chronic hypertension, ischaemic heart disease, stroke, venous thromboembolism and cardiovascular death6 7; evidence suggests that other features of the metabolic syndrome are present as well.8 Similarly, the development of an MPS has been shown to double the risk of development of cardiovascular disease later on in life.1 However, studies evaluating an association between HPDs and future arrhythmias and heart failure are limited.
Ray9 discusses these specific cardiovascular outcomes, heart failure and arrhythmias, in the context of a previous history of MPSs. In this unique retrospective cohort study, using a large administrative database in Ontario, Canada, the authors evaluate the frequency of these two outcomes in women with previous MPSs, defined as placental abruption, placental infarction, pre-eclampsia/eclampsia or gestational hypertension. Their primary composite outcome was hospitalisation …
