Long-term outcomes of hypertensive disorders of pregnancy

Dolgushina V.F., Syundyukova E.G., Chulkov V.S., Ryabikina M.G.

South Ural State Medical University, Ministry of Health of the Russian Federation, Chelyabinsk, Russia
The article reviews Russian and international literature published within the past five years on the relationship between hypertensive disorders of pregnancy and the risk of future chronic non-communicable diseases, including cardiovascular, cerebrovascular, chronic kidney diseases, and metabolic disorders. The review findings suggest that a history of hypertensive disorders of pregnancy confers a significant increase in the risk for chronic non-communicable diseases later in life. The authors identified a dose-dependent effect of early, severe, and recurrent preeclampsia on timing and the severity of chronic conditions and multimorbidity. This association somewhat weakens after adjustment for traditional risk factors (maternal age, smoking, family history of preeclampsia, obesity, hypertension, diabetes). However, underlying mechanisms for chronic non-communicable diseases after preeclampsia remain unclear. Besides, no regulatory documents define diagnostic, therapeutic, preventive measures for the rehabilitation of women with a history of preeclampsia. Clinical trials are required to validate primary and secondary prevention strategies for chronic somatic conditions in this population.
Conclusion: The review has underscored a need for continuity and professional cooperation of obstetric and internal medicine communities to develop interdisciplinary recommendations to minimize the risks of developing future chronic non-communicable diseases.

Keywords

hypertensive disorders of pregnancy
preeclampsia
chronic non-communicable diseases

References

  1. Основные показатели здоровья матери и ребенка, деятельность службы охраны детства и родовспоможения в Российской Федерации. 2018. Available at: https://minzdrav.gov.ru/ministry/61/22/stranitsa-979/statisticheskie-i-informatsionnye-materialy/statisticheskiy-sbornik-2018-god [The main indicators of maternal and child health, the activities of the child protection and maternity services in the Russian Federation. 2018. https://minzdrav.gov.ru/ministry/61/22/stranitsa-979/statisticheskie-i-informatsionnye-materialy/statisticheskiy-sbornik-2018-god (in Russian)].
  2. Melchiorre K., Thilaganathan B., Giorgione V., Ridder A., Memmo A., Khalil A. Hypertensive disorders of pregnancy and future cardiovascular health. Front. Cardiovasc. Med. 2020; 7: 59. https://dx.doi.org/10.3389/fcvm.2020.00059.
  3. Miller E.C. Preeclampsia and cerebrovascular disease. Hypertension. 2019; 74(1): 5-13. https://dx.doi.org/10.1161/HYPERTENSIONAHA.118.11513.
  4. Сидорова И.С., Никитина Н.А., Филиппов О.С., Гусева Е.В., Агеев М.Б., Кокин А.А. Решенные и нерешенные вопросы преэклампсии по результатам анализа материнской смертности за последние 10 лет. Акушерство и гинекология. 2021; 4: 64-74. [Sidorova I.S., Nikitina N.A., Filippov O.S., Guseva E.V., Ageev M.B., Kokin A.A. Solved and unresolved issues of preeclampsia based on the results of the analysis of maternal mortality over the past 10 years. Obstetrics and gynecology. 2021; 4: 64-74. (in Russian)]. https://dx.doi.org/10.18565/aig.2021.4.64-74.
  5. Cho G.J., Jung U.S., Sim J.Y., Lee Y.J., Bae N.Y., Choi H.J. et al. Is preeclampsia itself a risk factor for the development of metabolic syndrome after delivery? Obstet. Gynecol. Sci. 2019; 62(4): 233-41. https://dx.doi.org/10.5468/ogs.2019.62.4.233.
  6. Covella B., Vinturache A.E., Cabiddu G., Attin R., Gesualdo L., Versino E., Piccoli G.B. A systematic review and meta-analysis indicates long-term risk of chronic and end-stage kidney disease after preeclampsia. Kidney Int. 2019; 96(3): 711-27. https://dx.doi.org/10.1016/j.kint.2019.03.033.
  7. Ходжаева З.С., Холин А.М., Чулков В.С., Муминова К.Т. Ацетилсалициловая кислота в профилактике преэклампсии и ассоциированных акушерских и перинатальных осложнений. Акушерство и гинекология. 2018; 8: 12-8. [Khodzhaeva Z.S., Kholin A.M., Chulkov V.S., Muminova K.T. Acetylsalicylic acid in the prevention of preeclampsia and associated obstetric and perinatal complications. Obstetrics and gynecology. 2018; 8: 12-8. (in Russian)]. https://dx.doi.org/10.18565/aig.2018.8.12-18.
  8. Сюндюкова Е.Г., Чулков В.С., Рябикина М.Г. Преэклампсия: современное состояние проблемы. Доктор.Ру. 2021; 20(1): 11-6. [Syundyukova E.G., Chulkov V.S., Ryabikina M.G. Preeclampsia: the current state of the problem. Doctor.Ru. 2021; 20(1): 11-6. (in Russian)]. https://dx.doi.org/10.31550/1727-2378-2021-20-1-11-16.
  9. Benschop L., Duvekot J.J., Versmissen J., van Broekhoven V., Steegers E.A.P., Roeters van Lennep J.E. Blood pressure profile 1 year after severe preeclampsia. Hypertension. 2018; 71(3): 491-8. https://dx.doi.org/10.1161/HYPERTENSIONAHA.117.10338.
  10. Romundstad P.R., Magnussen E.B., Smith G.D., Vatten L.J. Hypertension in pregnancy and later cardiovascular risk: Common antecedents? Circulation. 2010; 122(6): 579-84. https://dx.doi.org/10.1161/CIRCULATIONAHA.110.943407.
  11. Mito A., Arata N., Qiu D., Sakamoto N., Murashima A., Ichihara A. et al. Hypertensive disorders of pregnancy: a strong risk factor for subsequent hypertension 5 years after delivery. Hypertens. Res. 2018; 41(2): 141-6. https://dx.doi.org/10.1038/hr.2017.100.
  12. Tooher J., Thornton C., Makris A., Ogle R., Korda A., Hennessy A. All hypertensive disorders of pregnancy increase the risk of future cardiovascular disease. Hypertension. 2017; 70(4): 798-803. https://dx.doi.org/10.1161/HYPERTENSIONAHA.117.09246.
  13. Hauspurg A., Countouris M.E., Jeyabalan A., Hubel C.A., Roberts J.M., Schwarz E.B., Catov J.M. Risk of hypertension and abnormal biomarkers in the first year postpartum associated with hypertensive disorders of pregnancy among overweight and obese women.. Pregnancy Hypertens. 2019; 15: 1-6. https://dx.doi.org/10.1016/j.preghy.2018.10.009.
  14. Brouwers L., van der Meiden-van Roest A.J., Savelkoul C., Vogelvang T.E., Lely A.T., Franx A. et al. Recurrence of pre-eclampsia and the risk of future hypertension and cardiovascular disease: a systematic review and meta-analysis. BJOG. 2018; 125(13): 1642-54. https://dx.doi.org/10.1111/1471-0528.15394.
  15. Cho G.J., Kim H.Y., Park J.H., Ahn K.H., Hong S.C., Kim H.J. et al. Prepregnancy factors are associated with development of hypertension later in life in women with pre-eclampsia. J. Womens Health. 2019; 28(7): 984-9. https://dx.doi.org/ 10.1089/jwh.2018.7165.
  16. Behrens I., Basit S., Melbye M., Lykke J.A., Wohlfahrt J., Bundgaard H. et al. Risk of post-pregnancy hypertension in women with a history of hypertensive disorders of pregnancy: nationwide cohort study. BMJ. 2017; 12: 358. https://dx.doi.org/10.1136/bmj.j3078.
  17. Groenhof T.K.J., Zoet G.A., Franx A., Gansevoort R.T., Bots M.L., Groen H. et al. Trajectory of cardiovascular risk factors after hypertensive disorders of pregnancy. Hypertension. 2019; 73(1): 171-8. https://dx.doi.org/10.1161/HYPERTENSIONAHA.118.11726.
  18. White W.M., Mielke M.M., Araoz P.A., Lahr B.D., Bailey K.R., Jayachandran M. et al. A history of preeclampsia is associated with a risk for coronary artery calcification 3 decades later. Am. J. Obstet. Gynecol. 2016; 214(4): 519.e1-519.e8. https://dx.doi.org/10.1016/j.ajog.2016.02.003.
  19. Zoet G.A., Benschop L., Boersma E., Budde R.P.J., Fauser B.C.J.M., van der Graaf Y. et al. Prevalence of subclinical coronary artery disease assessed by coronary computed tomography angiography in 45- to 55-year-old women with a history of preeclampsia. Circulation. 2018; 137(8): 877-9. https://dx.doi.org/10.1161/CIRCULATIONAHA.117.032695.
  20. Benschop L., Duvekot J.J., Roeters van Lennep J.E. Future risk of cardiovascular disease risk factors and events in women after a hypertensive disorder of pregnancy. Heart. 2019; 105(16): 1273-8. https://dx.doi.org/10.1136/heartjnl-2018-313453.
  21. Grand’Maison S., Pilote L., Schlosser K., Stewart D.J., Okano M., Dayan N. Clinical features and outcomes of acute coronary syndrome in women with previous pregnancy complications. Can. J. Cardiol. 2017; 33(12): 1683-92. https://dx.doi.org/10.1016/j.cjca.2017.08.025.
  22. Haug E.B., Horn J., Markovitz A.R., Fraser A., Klykken B., Dalen H. et al. Association of conventional cardiovascular risk factors with cardiovascular disease after hypertensive disorders of pregnancy: analysis of the nord-trøndelag health study. JAMA Cardiol. 2019; 4(7): 628-35. https://dx.doi.org/10.1001/jamacardio.2019.1746.
  23. Riise H.K.R., Sulo G., Tell G.S., Igland J., Nygård O., Iversen A.C. et al. Association between gestational hypertension and risk of cardiovascular disease among 617 589 Norwegian women. J. Am. Heart Assoc. 2018; 7(10): e008337. https://dx.doi.org/10.1161/JAHA.117.008337.
  24. Theilen L.H., Meeks H., Fraser A., Esplin M.S., Smith K.R., Varner M.W. Longterm mortality risk and life expectancy following recurrent hypertensive disease of pregnancy. Am. J. Obstet. Gynecol. 2018; 219(1): 107.e1-107.e6. https://dx.doi.org/10.1016/j.ajog.2018.04.002.
  25. Castleman J.S., Ganapathy R., Taki F., Lip G.Y., Steeds R.P., Kotecha D. Echocardiographic structure and function in hypertensive disorders of pregnancy: a systematic review. Circ. Cardiovasc. Imaging. 2016; 9(9): e004888. https://dx.doi.org/10.1161/CIRCIMAGING.116.004888.
  26. Breetveld N.M., Ghossein-Doha C., van Neer J., Sengers M.J.J.M., Geerts L., van Kuijk S.M.J. et al. Decreased endothelial function and increased subclinical heart failure in women several years after pre-eclampsia. Ultrasound Obstet. Gynecol. 2018; 52(2): 196-204. https://dx.doi.org/10.1002/uog.17534.
  27. Bokslag A., Franssen C., Alma L.J., Kovacevic I., Kesteren F.V., Teunissen P.W. et al. Early-onset preeclampsia predisposes to preclinical diastolic left ventricular dysfunction in the fifth decade of life: an observational study. PLoS ONne. 2018; 13(6): e0198908. https://dx.doi.org/10.1371/journal.pone.0198908.
  28. Soma-Pillay P., Louw M.C., Adeyemo A.O., Makin J., Pattinson R.C. Cardiac diastolic function after recovery from pre-eclampsia. Cardiovasc. J. Afr. 2018; 29(1): 26-31. https://dx.doi.org/10.5830/CVJA-2017-031.
  29. Orabona R., Vizzardi E., Sciatti E., Prefumo F., Bonadei I., Valcamonico A. et al. Maternal cardiac function after HELLP syndrome: an echocardiography study. Ultrasound Obstet. Gynecol. 2017; 50(4): 507-13. https://dx.doi.org/10.1002/uog.17358.
  30. Chen S.N., Cheng C.C., Tsui K.H., Tang P.L., Chern C.U., Huang W.C. et al. Hypertensive disorders of pregnancy and future heart failure risk: a nationwide population-based retrospective cohort study. Pregnancy Hypertens. 2018; 13: 110-5. https://dx.doi.org/10.1016/j.preghy.2018.05.010.
  31. Kuo Y.L., Chan T.F., Wu C.Y., Ker C.R., Tu H.P. Preeclampsia-eclampsia and future cardiovascular risk among women in Taiwan. Taiwan. J. Obstet. Gynecol. 2018; 57(3): 364-9. https://dx.doi.org/10.1016/j.tjog.2018.04.035.
  32. Сидорова И.С., Никитина Н.А., Тардов М.В., Стулин И.Д. Особенности церебрального кровотока при тяжелой преэклампсии и эклампсии. Акушерство и гинекология. 2020; 12: 90-9. [Sidorova I.S., Nikitina N.A., Tardov M.V., Stulin I.D. Features of cerebral blood flow in severe preeclampsia and eclampsia. Obstetrics and gynecology. 2020; 12: 90-9. (in Russian)]. https://dx.doi.org/10.18565/aig.2020.12.90-99.
  33. Siepmann T., Boardman H., Bilderbeck A., Griffanti L., Kenworthy Y., Zwager C. et al. Long-term cerebral white and gray matter changes after preeclampsia. Neurology. 2017; 88(13): 1256-64. https://dx.doi.org/10.1212/WNL.0000000000003765.
  34. Riise H.K.R., Sulo G., Tell G.S., Igland J., Egeland G., Nygard O. et al. Hypertensive pregnancy disorders increase the risk of maternal cardiovascular disease after adjustment for cardiovascular risk factors. Int. J. Cardiol. 2019; 282: 81-7. https://dx.doi.org/10.1016/j.ijcard.2019.01.097.
  35. Basit S., Wohlfahrt J., Boyd H.A. Pre-eclampsia and risk of dementia later in life: nationwide cohort study. BMJ. 2018; 363: k4109. https://dx.doi.org/10.1136/bmj.k4109.
  36. Elharram M., Dayan N., Kaur A., Landry T., Pilote L. Long-term cognitive impairment after preeclampsia: a systematic review and meta-analysis. Obstet. Gynecol. 2018; 132(2): 355-64. https://dx.doi.org/10.1097/AOG.0000000000002686.
  37. Тарасова О.А., Чулков В.С., Синицын С.П., Вереина Н.К., Чулков В.С. Факторы кардиометаболического риска у женщин с анамнезом артериальной гипертензии во время беременности. Артериальная гипертензия. 2019; 25(1): 97-104. [Tarasova O.A., Chulkov V.S., Sinitsyn S.P., Vereina N.K., Chulkov V.S. Factors of cardiometabolic risk in women with a history of arterial hypertension during pregnancy. Arterial hypertension. 2019; 25(1): 97-104. (in Russian]. https://dx.doi.org/10.18705/1607-419X-2019-25-1-97-104.
  38. Jenabi E., Afshari M., Khazaei S.J. The association between preeclampsia and the risk of metabolic syndrome after delivery: a meta-analysis. J. Matern. Fetal Neonatal Med. 2021; 34(19): 3253-8. https://dx.doi.org/10.1080/14767058.2019.1678138.
  39. Чулков В.С., Долгушина В.Ф., Вереина Н.К., Синицын С.П. Акушерские осложнения при различных формах артериальной гипертензии у беременных. Акушерство и гинекология. 2013; 10: 33-9. [Chulkov V.S., Dolgushina V.F., Vereina N.K., Sinitsyn S.P. Obstetric complications in various forms of arterial hypertension in pregnant women. Obstetrics and gynecology. 2013; 10: 33-9. (in Russian)].
  40. Липатов И.С., Тезиков Ю.В., Азаматов А.Р., Шмаков Р.Г. Общность клинических проявлений преэклампсии и метаболического синдрома: поиск обоснования. Акушерство и гинекология. 2021; 3: 81-9. [Lipatov I.S., Tezikov Yu.V., Azamatov A.R., Shmakov R.G. The commonality of clinical manifestations of preeclampsia and metabolic syndrome: the search for justification. Obstetrics and gynecology. 2021; 3: 81-9. (in Russian)]. https://dx.doi.org/10.18565/aig.2021.3.81-89.
  41. Hooijschuur M.C.E., Ghossein-Doha C., Kroon A.A., De Leeuw P.W., Zandbergen A.A.M., Van Kuijk S.M.J., Spaanderman M.E.A. Metabolic syndrome and pre-eclampsia. Ultrasound Obstet. Gynecol. 2019; 54(1): 64-71. https://dx.doi.org/10.1002/uog.20126.
  42. Khashan A.S., Evans M., Kublickas M., McCarthy F.P., Kenny L.C., Stenvinkel P. et al. Preeclampsia and risk of end stage kidney disease: A Swedish nationwide cohort study. PLoS Med. 2019; 16(7): e1002875. https://dx.doi.org/10.1371/journal.pmed.1002875.
  43. Brown H.L., Warner J.J., Gianos E., Gulati M., Hill A.J., Hollier L.M. et al.; American Heart Association and the American College of Obstetricians and Gynecologists. Promoting risk identification and reduction of cardiovascular disease in women through collaboration with obstetricians and gynecologists: A Presidential Advisory from the American Heart Association and the American College of Obstetricians and Gynecologists. Circulation. 2018; 137(24): e843-52. https://dx.doi.org/10.1161/CIR.0000000000000582.
  44. Duffy J., Cairns A.E., Richards-Doran D., van 't Hooft J., Gale C., Brown M. et al. A core outcome set for pre-eclampsia research: an international consensus development study. BJOG. 2020; 127(12): 1516-26. https://dx.doi.org/10.1111/1471-0528.16319.
  45. Miller E.C., Boehme A.K., Chung N.T., Wang S.S., Lacey J.V., Lakshminarayan K. et al. Aspirin reduces long-term stroke risk in women with prior hypertensive disorders of pregnancy. Neurology. 2019; 92(4): e305-16. https://dx.doi.org/10.1212/WNL.0000000000006815.

Received 14.07.2021

Accepted 27.07.2021

About the Authors

Valentina F. Dolgushina, Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology, South Ural State Medical University, Ministry of Health of the Russian Federation, +7(919)329-32-45, dolgushinavf@yandex.ru, 454091, Russia, Chelyabinsk, Vorovsky str., 64.
Elena G. Syundyukova, Dr. Med. Sci., Associate Professor, Professor of the Department of Obstetrics and Gynecology, South Ural State Medical University, Ministry of Health of the Russian Federation, +7(351)721-46-32, +7(900)027-08-82, seg269@mail.ru, 454091, Russia, Chelyabinsk, Vorovsky str., 64.
Vasiliy S. Chulkov, Dr. Med. Sci., Associate Professor, Professor of the Department of Faculty Therapy, South Ural State Medical University, Ministry of Health of the Russian Federation, +7(351)253-69-11, +7(922)698-2-328, vschulkov@rambler.ru, 454091, Russia, Chelyabinsk, Vorovsky str., 64.
Marya G. Ryabikina, doctor of the Department of Pathology of Pregnancy, Clinic of the South Ural State Medical University, Ministry of Health of the Russian Federation, +7(351)721-46-32, +7(919)311-2-488, mryabikina@mail.ru, 454091, Russia, Chelyabinsk, Cherkasskaya str., 2.

Authors' contributions: Dolgushina V.F., Syundyukova E.G. – conception and design of the study; Syundyukova E.G., Chulkov V.S. – data collection and analysis; Syundyukova E.G., Chulkov V.S., Ryabikina M.G. – manuscript drafting; Dolgushina V.F. – manuscript editing.
Conflicts of interest: The authors have no conflicts of interest to declare.
Funding: There was no funding for this study.
For citation: Dolgushina V.F., Syundyukova E.G., Chulkov V.S., Ryabikina M.G. Long-term outcomes of hypertensive disorders of pregnancy.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2021;10: 14-20 (in Russian)
https://dx.doi.org/10.18565/aig.2021.10.14-20

Similar Articles

By continuing to use our site, you consent to the processing of cookies that ensure the proper functioning of the site.