The Predictive Pregnancy: What Complicated Pregnancies Tell Us About Mother's Future Cardiovascular Risk
For the first time, the American Heart Association 2011 Guidelines on the Prevention of Cardiovascular Disease in Women named pregnancy complications as risk factors for cardiovascular disease1. The committee recommended that clinicians query a detailed history of gestational diabetes, preeclampsia, preterm delivery, or delivery of a small for gestational age neonate as part of routine clinical intake. They urged obstetricians to refer women with complicated pregnancies to primary care or cardiology for monitoring of cardiovascular risk factors. This novel recommendation is based largely on recent discoveries emerging from "big" epidemiology of linked national birth and death registry databases in Europe. These studies have shown consistent statistical associations between history of pregnancy complications and significantly increased risk of CVD in the decades after complex pregnancy2-9. Yet, based as they are on administrative records, these studies are largely silent on the clinical course from complicated pregnancy to CVD event. What, exactly, is a clinician to do with the knowledge that a history of pregnancy complications doubles CVD risk as a woman matures? To fulfill the promise of the AHA recommendation, we need data to determine appropriate prevention strategies, screening schedules, clinical targets, and treatment regimens for the large proportion of women who bear a telling history of complicated pregnancy10. (SELECT FULL TEXT TO CONTINUE)
- Received February 14, 2012.
- Accepted February 17, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited