May 15, 2019 | Erin Bluvas, bluvase@sc.edu
Women who experience adverse pregnancy outcomes are at an increased risk for future cardiovascular disease, according to a research review led by exercise science assistant professor Abbi Lane-Cordova. The paper, which synthesizes the current information and knowledge gaps regarding the progression of adverse pregnancy outcomes to cardiovascular disease in women, is the result of a collaboration between Lane-Cordova and researchers from Northwestern University. It was published in the Journal of the American College of Cardiology as the journal’s review topic of the week.
Adverse pregnancy outcomes are common interrelated disorders caused by placental dysfunction and maternal vascular reaction. They occur in approximately 10 to 20 percent of pregnancies and include problems such as pre-term birth, pre-eclampsia and intrauterine growth restriction. They are associated with an increased risk of cardiovascular disease, particularly hypertension, left ventricular hypertrophy/dysfunction, vascular dysfunction and renal dysfunction.
“The vascular abnormalities that are present during an adverse pregnancy outcome also underlie common, difficult-to-treat forms of cardiovascular disease in women as they age, such as cardiac microvascular dysfunction, heart failure with preserved ejection fraction,” Lane-Cordova says. “This suggests that adverse pregnancy outcomes and cardiovascular disease share mechanistic pathways.”
By synthesizing the current state of the research on this relationship, the authors have illuminated a better understanding of the risk factors for and pathogenesis of adverse pregnancy outcomes-related cardiovascular dysfunction. Their synopsis can help inform efforts to prevent and more effectively treat cardiovascular disease in women.
The paper includes an overview of the pathogenesis of adverse pregnancy outcomes and cardiovascular disease related to these outcomes, evidence for shared pathophysiology, and a discussion of cardiac adaptations during uncomplicated pregnancy versus pregnancies complicated by adverse pregnancy outcomes and cardiovascular disease. The authors also identify limitations of prior studies and highlight future directions for this area of research.
“Because cardiovascular disease risk is 1.8- to 4.0-fold higher in women who had an adverse pregnancy outcome, understanding how these outcomes may lead to cardiovascular disease is critical,” Lane-Cordova says. “This is especially important as cardiovascular disease mortality rates among women 35 to 44 years of age have been increasing on average over the two decades.”
The authors suggest that future research focus on determining the pathways by which adverse pregnancy outcomes lead to cardiovascular disease. They also recommend investigating whether behavioral or pharmacological interventions are effective for reducing adverse pregnancy outcomes-related cardiovascular risk.
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