Cardiovascular Consequences of Hypertensive Disorders of Pregnancy
Date
2020-01
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Abstract
Hypertensive disorders of pregnancy (HDP), including preeclampsia and gestational hypertension (GHTN), are independently associated with increased maternal cardiovascular risk. Endothelial dysfunction is one of the crucial pathophysiology of preeclampsia and might be the connection between preeclampsia and future cardiovascular risk. The postpartum period offers a time window to identify and begin to manage modifiable cardiovascular risk factors. However, limited studies have focused on the first years postpartum and the opportunity for early cardiovascular prevention may be lost. Few studies have longitudinally observed the changes of vascular function by different measures. The aims of this study were to detect: Subsequent hypertension, diabetes and dyslipidemia in women with/without HDP over the first years postpartum by linking three administrative databases. The alterations of vascular function during pregnancy by using flow-mediated vasodilation (FMD), hyperemic velocity-time integral (VTI) and peripheral artery tonometry (PAT), and the relationship between vascular function indices and utero-placental ultrasonographic and biochemical markers. Our results highlighted women with HDP had higher odds of hypertension (GHTN adjusted OR [aOR]: 5.82[4.96-6.83]; preeclampsia: aOR: 4.97[3.63-6.81]), dyslipidemia (GHTN: aOR: 2.22[1.47-3.35]; preeclampsia: aOR: 1.41[1.10-1.80]), and diabetes (GHTN: aOR: 2.26[1.50, 13.4]; PE: 2.02[0.91, 4.46]) during 4 years postpartum than the normotensive pregnancy. Half of the women with HDP had no lipid testing. They were not more likely to be tested than normotensive women after adjusting for confounders. Women with GHTN and preeclampsia had less favorable and more atherogenic lab results than the normal controls. Non-significant changes of FMD and hyperemic VTI over pregnancy were detected. The PAT index declined consistently during pregnancy and this may have been related to vasodilator changes of baseline pulse wave amplitude. The uterine artery pulsatility index (UtA-PI) was not correlated with the standard measures of endothelial function. There were mild correlations between UtA-PI and baseline flow, sFlT-1 and ln(sFlt-1/PlGF ratio) with baseline flow and baseline VTI in the first trimester. Our study implies the needs of early postpartum screening for hypertension, dyslipidemia and dysglycemia in women with HDP. FMD, hyperemic VTI and PAT index might not be directly used as markers to represent the macrovascular and microvascular function during pregnancy.
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Keywords
Hypertensive disorders of pregnancy, Gestational hypertension, Preeclampsia, Vascular function
Citation
Wen, C. (2020). Cardiovascular Consequences of Hypertensive Disorders of Pregnancy (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.