Women with preeclampsia have a higher chance of heart attack and stroke than their peers within seven years after giving birth, and risks remain elevated more than 20 years later. The study on more than a million pregnant women is published today in the European Journal of Preventive Cardiology , a journal of the ESC.
“The high risk of cardiovascular disease after preeclampsia manifests itself at early ages and shortly after childbirth,” said study author Dr. Sara Hallum, of the University of Copenhagen, Denmark. "This indicates that interventions to prevent heart attacks and strokes in affected women cannot wait until midlife when they are eligible for conventional cardiovascular screening programs."
Preeclampsia affects up to 8% of pregnancies worldwide.
Medical signs are high blood pressure and protein in the urine, which develop after 20 weeks of pregnancy or shortly after delivery. Symptoms include severe headache, stomach pain and nausea. "Women may mistake them for ’normal’ pregnancy symptoms and therefore not seek medical help until the condition becomes serious," Dr. Hallum said. “Most cases are mild, but preeclampsia can lead to serious complications for the mother and baby if not treated in time.”
It is well established that preeclampsia predisposes women to an increased likelihood of cardiovascular disease later in life.3 This was the first study to examine how soon after pregnancy these heart attacks and strokes occur, and the magnitude of the effect. risk in different age groups.
National registries were used to identify all pregnant women in Denmark between 1978 and 2017. Women were grouped into those with one or more pregnancies complicated by preeclampsia and those without preeclampsia. The participants were free of cardiovascular disease before pregnancy and were followed for up to 39 years for heart attack and stroke. Dr Hallum said: "This allowed us to assess exactly when cardiovascular disease occurs in women with and without pre-eclampsia, and to estimate the risk in different age groups and at various follow-up durations."
The study included 1,157,666 women. Up to 2% of women with preeclampsia in their first pregnancy had a heart attack or stroke within two decades after giving birth, compared with up to 1.2% of unaffected women. Differences in risk became evident seven years after delivery. “A 2% incidence of acute myocardial infarction and ischemic stroke should not be accepted as the cost of a pregnancy complicated by preeclampsia, especially considering the young age of these women when they become ill (less than 50 years),” the paper states.
Overall, women with preeclampsia were four times more likely to have a heart attack and three times more likely to have a stroke within 10 years after giving birth than those without preeclampsia. The risk of heart attack or stroke remained twice as high in the preeclampsia group more than 20 years after giving birth compared to unaffected women.
When researchers examined cardiovascular disease risk by age, they found that women ages 30 to 39 with a history of preeclampsia had five and three times higher rates of heart attack and stroke, respectively, than similar women. age without history of preeclampsia. The increased likelihood of cardiovascular disease in those with a history of preeclampsia persisted throughout adulthood, and women over age 50 still had twice the risk compared to their peers without a history of pregnancy complications.
Dr Hallum said: “Women are often in contact with the healthcare system during and immediately after pregnancy, providing an opportunity to identify people at increased risk of cardiovascular disease. The number of women with prior preeclampsia is large and routine follow-up could take years or even decades. Our study suggests that women most likely to benefit from screening are those who had preeclampsia after age 35 and those who had it more than once. "Prevention should begin within a decade after giving birth, for example by treating high blood pressure and educating women about risk factors for heart disease, such as smoking and inactivity."
