Metabolic Syndrome Sharply Boosts Risk of Recurrent Pre-Eclampsia

March 21, 2013

By Anne Harding

NEW YORK (Reuters Health) Mar 21 - Metabolic syndrome more than triples a woman's risk of recurrent pre-eclampsia, according to a new retrospective cohort study.

"Interpregnancy metabolic syndrome predisposes women to recurrent pre-eclampsia," Dr. Eva Stekkinger of Deventer Hospital in The Netherlands told Reuters Health via email. "In our study the prevalence of recurrent pre-eclampsia in the subsequent pregnancy was 45% in women with interpregnancy metabolic syndrome compared to 17% in women without metabolic syndrome."

Dyslipidemia and insulin resistance, two components of metabolic syndrome, occur more frequently in pregnancies complicated by pre-eclampsia, and often persist after gestation, Dr. Stekkinger and her team note in their report, published online March 6 in BJOG. Endothelial dysfunction is an early sign of both metabolic syndrome and pre-eclampsia, they add.

To investigate their hypothesis that pre-eclampsia would be more likely to recur in women with interpregnancy metabolic syndrome, the researchers looked at 480 women with pre-eclampsia during a previous pregnancy. They were able to find outcome data for a subsequent pregnancy for 197 of the women.

Forty of these women, or 20%, had metabolic syndrome. In this subgroup, 18 women (45%) developed pre-eclampsia in their subsequent pregnancy, compared to 27 of the 157 women who did not have metabolic syndrome (17%). The adjusted odds ratio for recurrent pre-eclampsia associated with metabolic syndrome was 3.77.

For each component of the metabolic syndrome a woman had, her risk of recurrent pre-eclampsia increased; women with none of the components had an 11.8% risk, versus 43.9% for women with three or more components.

"The high prevalence of metabolic syndrome after pre-eclampsia, the remote sequelae of metabolic syndrome and the proven lifestyle interventions to lower these risks, all favor the recommendation to screen all women after pre-eclampsia for metabolic syndrome to support tailored risk estimation and modification," Dr. Stekkinger told Reuters Health.

"Other studies show that there is substantial evidence that women after a pre-eclamptic gestation have increased risk of developing, and even dying from, cardiovascular disease at a relatively young age," she added in an interview. "As interpregnancy metabolic syndrome relates to recurrent pre-eclampsia it may be that these women are at highest risk of developing cardiovascular disease. Optimizing maternal health before conception or during early pregnancy seems to be a promising strategy in reducing gestational vascular risks."

Telling young patients with metabolic syndrome that the condition can increase their likelihood of problems during pregnancy may be a more powerful way to motivate them to change their lifestyle than warning them about later-life risks of heart disease and diabetes, Dr. Mary Rosser, an OB/GYN at Montefiore Medical Center in New York City, told Reuters Health.

"We need to raise the red flag and raise awareness and say these are the problems that you can have down the line," Dr. Rosser, who was not involved in Dr. Stekkinger's study, told Reuters Health. "This gives us more ammunition to say we need to be diagnosing metabolic syndrome or even preventing it before it happens in the younger person."


BJOG 2013.