SAN FRANCISCO, CA — Women who develop preeclampsia early, before week 34 of pregnancy, have more pronounced left ventricular concentric remodeling 1 month after delivery than women with late-onset preeclampsia, new research suggests[1].

"It has been established that women with pregnancy complicated by hypertensive disorders have a higher cardiovascular risk than women of the same age without pregnancy complications. We have shown that early-onset preeclampsia seems to exert a greater risk than the later-onset form, as we have documented by finding a greater left ventricular concentric remodeling in these women," Dr GianLuca Colussi (University of Udine, Italy) told | Medscape Cardiology.

"The main message is that these women need to be screened and treated for cardiovascular risks as soon as possible and a regular follow-up for cardiovascular disease prevention should be implemented after delivery and all . . . the woman's life," said Colussi.

The study was presented September 14 at the 2017 American Heart Association (AHA) Council on Hypertension, AHA Council on Kidney in Cardiovascular Disease, American Society of Hypertension Joint Scientific Sessions.

Early-onset preeclampsia presenting before week 34 of pregnancy is a more severe form of the disease, but its relevance on cardiac abnormalities in the postpartum period in comparison with later-onset preeclampsia is not clear, the researchers note.

Colussi and colleagues studied cardiac structure and function of 65 women who were normotensive before pregnancy but who developed preeclampsia while pregnant.

Twenty-four women had early-onset preeclampsia (before week 34 of pregnancy). For comparison, the study also included 16 hypertensive nonpregnant women, six healthy pregnant women, and 30 nonpregnant women.

One month after giving birth, left ventricle relative wall thickness was significantly greater in women with early preeclampsia than in those with late preeclampsia (P<0.05) and normotensive women (P<0.05), but not hypertensive women.

Women with early preeclampsia also had comparably greater left ventricular mass and worse diastolic function as assessed by the E/A ratio (P<0.01) and isovolumic relaxation time (P<0.001) than normotensive women.

These observations "could account for the greater cardiovascular risk of these patients and might prompt the use of antihypertensive drugs specifically acting on left ventricular remodeling," the researchers conclude in their conference abstract.

"It's not clear what percentage of women present with an early- or a late-onset form of preeclampsia, since this percentage depends on different factors such as origins, ethnicity, culture, and definitions of preeclampsia and early-onset preeclampsia," Colussi commented. "In our study, of women mainly of [European] origin, the percentage of the early-onset form of preeclampsia (before the 34th week of gestation) was 37%."

Long-term Impact

Commenting on the study for | Medscape Cardiology, AHA spokesperson Dr Willie Lawrence, Jr (Midwest Heart & Vascular Specialists, Kansas City, MO), said, "The implication of the study is that things that happen during pregnancy can have long-term impacts, and we know that left ventricular hypertrophy is a big predictor of cardiac events in the future."

The findings, he added, "imply that when you see preeclampsia early on, you are more likely to see later left ventricular hypertrophy much like you would see in patients with chronic hypertension.

"All I would say is that you want to make certain that so-called early preeclampsia is not really a sign of preexisting hypertension and that's why you see these changes because this person didn't just develop hypertension during pregnancy," he concluded.

The authors report no relevant financial relationships.  


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: