Preeclampsia is a potentially dangerous pregnancy complication while cardiovascular disease is the leading cause of maternal mortality in the U.S. Cardiologist Erin Michos speaks on the relationship between preeclampsia and cardiovascular disease and the impact it can have on women’s health.
mm Hi, I'm Dr Aaron Nikos. I'm an associate professor in cardiology who specializes in women's cardiovascular health and cardio obstetrics, card obstetrics is the field that focus on the intersection of pregnancy, both normal and abnormal pregnancies and heart health. And so this relates to both providing guidance to women who have underlying cardiovascular disease to help them have a safer pregnancy, but also for women who might not have known to have cardiovascular disease prior to the start of pregnancy, understanding the impact of adverse pregnancy outcomes on long term maternal cardiovascular risk. So, I'm going to give to talks with the American Heart Association 2021 scientific sessions related to this topic. My first talk was about Prick Lancia, but first, I just want to highlight the impact that maternal mortality is rising in the United States and it disproportionately affects black women in american indian Alaska. Native women who are 2 to 3 times more likely to die from pregnancy complication than white women. And you know, we're having this talk at the american Heart Association meeting because cardiovascular disease remains the leading cause of death and maternal mortality. And we think that three out of five of pregnancy related deaths could be preventable. So my first talk is about preeclampsia. Preeclampsia affects 5-8% of pregnancies and it's a pregnancy complication associated with high blood pressure and evidence of organ damage, usually to the kidney or the liver that emerges after 20 weeks of gestation. This can occur in women who previously had a normal blood pressure, but it also can be superimposed on women who had chronic hypertension prior to pregnancy, which remains a high risk factor. And we know that pre eclampsia is associated with both acute cardiovascular complications at the time of delivery. We published on this recently in the journal hypertension, which is an h a journal about the increased risk of short term complications of heart failure and peri partum cardiomyopathy. But it's also now well recognized that these cardiovascular risks extend, you know, many, many years beyond pregnancy even to later in life. But these risk even a decade or more after the index pregnancy that women with a history of a pregnant pregnancy are about to fold, increased risk of having a future cardiovascular events such as a heart attack or a stroke and therefore fold increased risk of having heart failure. And so there's a lot of opportunities for clinicians to implement prevention to reduce uh this elevated risk um you know, in the short term for women who are pregnant and having a pregnancy associated with prick Lancia. Um you know, after delivery, there's an emergence of postpartum transitional clinics, uh pre eclampsia clinics. Uh We call this the sort of the fourth trimester care where we help transition these women into longer term of primary care. We really want to make sure that they get their blood pressure checked post delivery and you know, it can be hard for women who just delivered and have infinite home to go to follow up visits. And there's been a lot of use interest in using things like apps and home blood pressure monitoring to help engage women to be active in their own blood pressure management care and patient centered lifestyle interventions. But even longer term, I want to have a plea for clinicians to take a comprehensive reproductive history to ask women about their prior pregnancies. Women remember their pregnancies very well and we just need to ask them because we'll identify women at higher risk that may not be reflected by their traditional risk factors. And although I'm talking about frequency in this talk, we also know that the adverse pregnancy outcomes of gestational diabetes, preterm delivery small for gestational age infant also is associated with increased risk. Mm. Mhm. So, you know, why is pre eclampsia and vascular disease? You know related. What is the chicken versus the egg? Well, it's thought that proclaims and vascular disease share a lot of mechanisms in common. There's a lot of shared risk factors that can lead in the familial dysfunction. But it's also thought that maybe pre eclampsia directly confers increased cardiovascular risk in a causal fashion such as the inflammatory and robotic malu a protected pregnancy. The sensitivity to certain hormones like angie attention to make further propagate in the Chilean ambassador damage. That sets these women up for later life cardiovascular risk. And so in this talk, I was specifically talking about Prick Lancia. But it's important to note that there's other adverse pregnancy outcomes such as gestational diabetes. Preterm delivery, small for gestational age infants, is also associated with cardiovascular risk.
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