Long-Term Cardiovascular Risks Associated With Adverse Pregnancy Outcomes: JACC Review Topic of the Week

Adverse pregnancy outcomes (APOs)-including pre-term birth, pre-eclampsia, and intrauterine growth restriction-are common interrelated disorders caused by placental dysfunction and maternal vascular abnormalities (endothelial activation, inflammation, and vasospasm) that occur in approximately 10% t...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 2019-04, Vol.73 (16), p.2106-2116
Main Authors: Lane-Cordova, Abbi D, Khan, Sadiya S, Grobman, William A, Greenland, Philip, Shah, Sanjiv J
Format: Article
Language:English
Subjects:
Abnormalities
Adult
Cardiology
Cardiovascular disease
Cardiovascular diseases
Cardiovascular Diseases - epidemiology
Cardiovascular Diseases - etiology
Congestive heart failure
Female
Follow-Up Studies
Health risk assessment
Health risks
Humans
Hypertension
Hypertrophy
Incidence
Microvasculature
Placenta
Pre-eclampsia
Pre-Eclampsia - epidemiology
Preeclampsia
Pregnancy
Pregnancy Complications - epidemiology
Pregnancy Complications - physiopathology
Pregnancy Outcome
Pregnancy, High-Risk
Premature birth
Renal function
Risk analysis
Risk Assessment
Risk factors
Time Factors
Vasoconstriction
Veins & arteries
Ventricle
Womens health
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Summary:Adverse pregnancy outcomes (APOs)-including pre-term birth, pre-eclampsia, and intrauterine growth restriction-are common interrelated disorders caused by placental dysfunction and maternal vascular abnormalities (endothelial activation, inflammation, and vasospasm) that occur in approximately 10% to 20% of pregnancies. Women who experience APOs are at increased risk for future cardiovascular disease (CVD). APOs are associated with increased risk of development of hypertension, left ventricular hypertrophy/dysfunction, vascular dysfunction, and renal dysfunction. The vascular abnormalities that are present during an APO also underlie common, difficult-to-treat forms of CVD in women as they age (e.g., cardiac microvascular dysfunction, heart failure with preserved ejection fraction), suggesting shared mechanistic pathways for APOs and CVD. Here, the authors synthesize the current information and knowledge gaps regarding the progression from APO to CVD. Understanding the risk factors for and pathogenesis of APO-related cardiovascular dysfunction is a critical unmet need that could inform efforts to prevent and more effectively treat CVD in women.
ISSN:0735-1097
1558-3597
DOI:10.1016/j.jacc.2018.12.092