More Evidence Ties Preeclampsia to Long-Term Diastolic Dysfunction

By Lisa Rapaport

July 30, 2019

(Reuters Health) - Women who develop preeclampsia may face a wide variety of heart problems long after they give birth, a research review concludes.

"This review demonstrates that the cardiac dysfunction associated with previous pre-eclampsia is quantifiable and persistent. Progression of heart failure from asymptomatic to symptomatic stages carries a fivefold increase in mortality," write the authors.

"The use of echocardiography could detect cardiac dysfunction in the asymptomatic stage and guide more intensive risk factor modification in these women," they say.

Archana Thayaparan from Western Health in Victoria, Australia and colleagues examined results from 13 studies that measured cardiac function by transthoracic echocardiography between 6 months and 18 years following a pregnancy complicated by pre‐eclampsia.

"This is important for patients as no large studies have been done to investigate this, and most women with pre-eclampsia are unaware of the potential long-term consequences and increased risk of heart disease and stroke," Thayaparan said by email.

Gestational hypertension is fairly common, affecting 6% to 8% of pregnant women. This condition can progress to more serious and potentially life-threatening preeclampsia later in pregnancy. Women with preeclampsia are more likely to develop diastolic dysfunction.

In the study, about 19 percent of women with a history of preeclampsia developed diastolic dysfunction, compared with 5.4% of women with uncomplicated pregnancies.

With a history of preeclampsia, about 25% of women went on to develop heart failure within 4 to 10 years of giving birth, compared with 7% of women with uncomplicated pregnancies, the researchers note in a paper in the Australasian Journal of Ultrasound Medicine.

The study wasn't designed to determine whether preeclampsia directly causes later heart problems, or if it might be an early sign of existing problems that emerge under the pressure of pregnancy on a woman's body.

"Previous research has shown that traditional cardiovascular risk factors such as BMI and blood pressure play a central role in the development of cardiovascular disease in women who experienced preeclampsia," said Eirin Haug, a public health researcher at the Norwegian University of Science and Technology in Trondheim, who wasn't involved in the study.

Doctors currently advise women with a history of preeclampsia to make lifestyle changes like losing weight, exercising, and eating a heart-healthy diet and to get regular blood pressure checks, Haug said by email.

"We still lack evidence for the effect of screening and lifestyle modifications on reducing cardiovascular risk in these women," Haug said. "More research is needed to tailor effective strategies to prevent cardiovascular disease in this group of women."


Australas J Ultrasound Med 2019.