Cardiovascular consequences of great obstetrical syndromes

DOI

https://dx.doi.org/10.18565/aig.2022.287

Akhmadeev N.R., Fatkullin I.F., Fatkullina L.S.
1) Kazan State Medical University, Ministry of Health of the Russian Federation, Kazan, Russia; 2) City Clinical Hospital No. 16, Kazan, Russia

The great obstetrical syndromes (GOS) are a term that summarizes major obstetric complications from a pathogenesis perspective. It includes preterm labor, pre-labor rupture of membranes, pre-eclampsia, fetus small for gestational age (low birth weight), and other conditions. The pathogenesis of GOS includes immune and vascular elements, which, among others, determine its effects on the cardiovascular system. Preeclampsia is the most studied complication of pregnancy in terms of the development of cardiovascular complications, including arterial hypertension, impaired cardiac function, risk of cardiovascular events, and mortality. Fetal growth restriction and preterm birth are not accompanied by the development of critical organ dysfunction; however, the common pathogenesis determines the risk of future cardiovascular events. The cardiovascular risk in patients with obstetric complications is elevated even before pregnancy; therefore, the development of GOS may trigger the development of complications. Despite the existence of some evidence base on the consequences of GOS, patient follow-up is not organized, and a regulatory framework has not been developed. The Russian Federation has no regulatory framework for the inclusion of such patients in outpatient medical supervision. Early diagnosis and appropriate rehabilitation can minimize the risk of long-term sequelae.
Conclusion: The data presented in this review indicate a high incidence of cardiovascular events following obstetric complications. The development of a methodology, forms of implementation, and recommendations for rehabilitation based on interdisciplinary interaction and continuity can become a new direction for scientific research and organizational solutions to this important problem.

Authors' contributions: Fatkullin I.F. – author of the idea, analysis of the state of the problem; Akhmadeev N.R. – data collection, systematization, data analysis, manuscript drafting; Fatkullina L.S. – author of the idea and its development.
Conflicts of interest: The authors have no conflicts of interest to declare.
Funding: There was no funding for this study.

For citation: Akhmadeev N.R., Fatkullin I.F., Fatkullina L.S. Cardiovascular consequences of great obstetrical syndromes.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2023; (4): 5-11 (in Russian)
https://dx.doi.org/10.18565/aig.2022.287

great obstetrical syndromes

cardiovascular disease

mortality

GOS

pre-eclampsia

preterm delivery

fetal growth restriction

Full text (in Russian)

Romero R. The child is the father of the man. Prenat. Neonat. Med. 1996; 1: 8‑11.
Romero R. Prenatal medicine: the child is the father of the man. 1996. J. Matern. Fetal Neonatal Med. 2009; 22(8): 636‑9. https://dx.doi.org/10.1080/14767050902784171.
Romero R., Espinoza J., Kusanovic J.P., Gotsch F., Hassan S., Erez O. et al. The preterm parturition syndrome. BJOG. 2006; 113(Suppl. 3): 17‑42. https://dx.doi.org/10.1111/j.1471‑0528.2006.01120.x.
Di Renzo G.C. The great obstetrical syndromes. J. Matern. Fetal Neonatal Med. 2009; 22(8): 633‑5. https://dx.doi.org/10.1080/14767050902866804.
Brosens I., Pijnenborg R., Vercruysse L., Romero R. The "Great Obstetrical Syndromes" are associated with disorders of deep placentation. Am. J. Obstet. Gynecol. 2011; 204(3): 193‑201. https://dx.doi.org/10.1016/j.ajog.2010.08.009.
Cabero Roura L., Hod M. Identification, prevention, and monitoring of the "great obstetrical syndromes". Best Pract. Res. Clin. Obstet. Gynaecol. 2015; 29(2): 145‑9. https://dx.doi.org/10.1016/j.bpobgyn.2014.10.001.
Jung E., Romero R., Yeo L., Gomez-Lopez N., Chaemsaithong P., Jaovisidha A. et al. The etiology of preeclampsia. Am. J. Obstet. Gynecol. 2022; 226(Suppl. 2): S844‑S866. https://dx.doi.org/10.1016/j.ajog.2021.11.1356.
Kosińska-Kaczyńska K. Placental syndromes‑a new paradigm in perinatology. Int. J. Environ. Res. Public Health. 2022; 19(12): 7392. https://dx.doi.org/10.3390/ijerph19127392.
Staff A.C. The two‑stage placental model of preeclampsia: an update. J. Reprod. Immunol. 2019; 134‑135: 1‑10. https://dx.doi.org/10.1016/j.jri.2019.07.004.
Gomez-Lopez N., Galaz J., Miller D., Farias-Jofre M., Liu Z., Arenas- Hernandez M. et al. The immunobiology of preterm labor and birth: intra‑amniotic inflammation or breakdown of maternal‑fetal homeostasis. Reproduction. 2022; 164(2): R11‑R45. https://dx.doi.org/10.1530/ REP‑22‑0046.
Redman C.W.G., Staff A.C., Roberts J.M. Syncytiotrophoblast stress in preeclampsia: the convergence point for multiple pathways. Am. J. Obstet. Gynecol. 2022; 226(Suppl. 2): S907‑S927. https://dx.doi.org/10.1016/ j.ajog.2020.09.047.
Jaiman S., Romero R., Bhatti G., Jung E., Gotsch F., Suksai M. et al. The role of the placenta in spontaneous preterm labor and delivery with intact membranes. J. Perinat. Med. 2022; 50(5): 553‑66. https://dx.doi.org/10.1515/jpm‑2021‑ 0681.
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. Cerebral blood flow in severe pre‑eclampsia and eclampsia. Obstetrics and Gynecology. 2020; (12): 90‑9. (in Russian)]. https://dx.doi.org/10.18565/aig.2020.12.90‑99.
Храмченко Н.В., Воеводин С.М., Андронова Н.В. Изменение церебральной гемодинамики при различных формах артериальной гипертензии в третьем триместре беременности. Акушерство и гинекология. 2017; 4: 81‑6. [Khramchenko N.V., Voevodin S.M., Andronova N.V. Cerebral hemodynamic changes in different forms of hypertension in the third trimester of pregnancy. Obstetrics and Gynecology. 2017; (4): 81‑6. (in Russian)]. https://dx.doi.org/10.18565/aig.2017.4.81‑6.
Цывьян П.Б., Мальгина Г.Б., Косовцова Н.В., Маркова Т.В., Салимова Н.А. К системной патофизиологии преэклампсии: роль нарушений венозной гемодинамики матери и функции почек. Акушерство и гинекология. 2021; 4: 5‑11. [Tsyvian P.B., Malgina G.B., Kosovtsova N.V., Markova T.V., Salimova N.A. On systemic pathophysiology of preeclampsia: the role of maternal venous hemodynamic disorders and renal dysfunction. Obstetrics and Gynecology. 2021; (4): 5‑11. (in Russian)]. https://dx.doi.org/10.18565/ aig.2021.4.5‑11.
Sławek-Szmyt S., Kawka-Paciorkowska K., Ciepłucha A., Lesiak M., Ropacka- Lesiak M. Preeclampsia and fetal growth restriction as risk factors of future maternal cardiovascular disease ‑ a review. J. Clin. Med. 2022; 11(20): 6048. https://dx.doi.org/10.3390/jcm11206048.
Sukmanee J., Liabsuetrakul T. Risk of future cardiovascular diseases in different years postpartum after hypertensive disorders of pregnancy: a systematic review and meta‑analysis. Medicine (Baltimore). 2022; 101(30): e29646. https://dx.doi.org/10.1097/MD.0000000000029646.
Haßdenteufel K., Müller M., Gutsfeld R., Goetz M., Bauer A., Wallwiener M. et al. Long‑term effects of preeclampsia on maternal cardiovascular health and postpartum utilization of primary care: an observational claims data study. Arch. Gynecol. Obstet. 2023; 307(1): 275‑84. https://dx.doi.org/10.1007/ s00404‑022‑06561‑w.
Ormesher L., Higson S., Luckie M., Roberts S.A., Glossop H., Trafford A. et al. Postnatal cardiovascular morbidity following preterm pre‑eclampsia: an observational study. Pregnancy Hypertens. 2022; 30: 68‑81. https://dx.doi.org/10.1016/j.preghy.2022.08.007.
McCarthy F.P., O'Driscoll J., Seed P., Brockbank A., Cox A., Gill C. et al. Planned delivery to improve postpartum cardiac function in women with preterm pre‑eclampsia: the PHOEBE mechanisms of action study within the PHOENIX RCT. Efficacy Mech. Eval. 2021; 8(12).
Ackerman-Banks C.M., Grechukhina O., Spatz E., Lundsberg L., Chou J., Smith G. et al. Seizing the window of opportunity within i year postpartum: early cardiovascular screening. J. Am. Heart Assoc. 2022; 11(8): e024443. https://dx.doi.org/10.1161/JAHA.121.024443.
Turbeville H.R., Sasser J.M. Preeclampsia beyond pregnancy: long‑term consequences for mother and child. Am. J. Physiol. Renal Physiol. 2020; 318(6): F1315‑F1326. https://dx.doi.org/10.1152/ajprenal.00071.2020.
Pustjens T.F.S., Vranken N.P.A., Jansen G., Winkler P.J.C., Stein M., Hoebers L. et al. Prevalence of a history of metabolic or hypertensive pregnancy disorder in patients with myocardial infarction and non‑obstructive coronary arteries: an observational cohort study. Front. Cardiovasc. Med. 2022; 9: 932799. https://dx.doi.org/10.3389/fcvm.2022.932799.
Hansen A.L., Søndergaard M.M., Hlatky M.A., Vittinghof E., Nah G., Stefanick M.L. et al. Adverse pregnancy outcomes and incident heart failure in the women's health initiative. JAMA Netw. Open. 2021; 4(12): e2138071. https://dx.doi.org/10.1001/jamanetworkopen.2021.38071.
Wu P., Haththotuwa R., Kwok C.S., Babu A., Kotronias R.A., Rushton C. et al. Preeclampsia and future cardiovascular health: a systematic review and meta‑analysis. Circ. Cardiovasc. Qual. Outcomes. 2017; 10(2): e003497. https://dx.doi.org/10.1161/CIRCOUTCOMES.116.003497.
de Havenon A., Delic A., Stulberg E., Sheibani N., Stoddard G., Hanson H. et al. Association of preeclampsia with incident stroke in later life among women in the framingham heart study. JAMA Netw. Open. 2021; 4(4): e215077. https://dx.doi.org/10.1001/jamanetworkopen.2021.5077.
Ray J.G., Booth G.L., Alter D.A., Vermeulen M.J. Prognosis after maternal placental events and revascularization: PAMPER study. Am. J. Obstet. Gynecol. 2016; 214(1): 106.e1‑106.e14. https://dx.doi.org/10.1016/j.ajog.2015.08.021.
Sandvik M.K., Leirgul E., Nygård O., Ueland P.M., Berg A., Svarstad E. et al. Preeclampsia in healthy women and endothelial dysfunction 10 years later. Am. J. Obstet. Gynecol. 2013; 209(6): 569.e1‑e10. https://dx.doi.org/10.1016/ j.ajog.2013.07.024.
Sciatti E., Orabona R. A window of opportunity on cardiovascular prevention: pre‑eclampsia and fetal growth restriction. Eur. J. Prev. Cardiol. 2022; 28(16): e17‑e18. https://dx.doi.org/10.1177/2047487320925646.
Rich-Edwards J.W., Fraser A., Lawlor D.A., Catov J.M. Pregnancy characteristics and women's future cardiovascular health: an underused opportunity to improve women's health? Epidemiol. Rev. 2014; 36(1): 57‑70. https://dx.doi.org/10.1093/epirev/mxt006.
Orabona R., Mohseni Z., Sciatti E., Mulder E.G., Prefumo F., Lorusso R. et al. Maternal myocardial dysfunction after normotensive fetal growth restriction compared with hypertensive pregnancies: a speckle‑tracking study. J. Hypertens. 2020; 38(10): 1955‑63. https://dx.doi.org/10.1097/HJH.0000000000002496.
Torosyan N., Aziz D., Quesada O. Long‑term sequelae of adverse pregnancy outcomes. Maturitas. 2022; 165: 1‑7. https://dx.doi.org/10.1016/ j.maturitas.2022.06.012.
Gao L., Bowe S.J., Moodie M. Preterm delivery and increased risk of recurrent cardiovascular events in Australian women. J. Womens Health (Larchmt). 2022; 31(12): 1773‑81. https://dx.doi.org/1089/jwh.2022.0091.
Cho G.J., Um J.S., Kim S.J., Han S.W., Lee S.B., Oh M.J. et al. Prior pregnancy complications and maternal cardiovascular disease in young Korean women within 10 years after pregnancy. BMC Pregnancy Childbirth. 2022; 22(1): 229. https://dx.doi.org/10.1186/s12884‑022‑04578‑2.
Tanz L.J., Stuart J.J., Williams P.L., Rimm E.B., Missmer S.A., Rexrode K.M. et al. Preterm delivery and maternal cardiovascular disease in young and middle‑aged adult women. Circulation. 2017; 135(6): 578‑89. https://dx.doi.org/10.1161/CIRCULATIONAHA.116.025954.
Täufer Cederlöf E., Lundgren M., Lindahl B., Christersson C. Pregnancy complications and risk of cardiovascular disease later in life: a nationwide cohort study. J. Am. Heart Assoc. 2022; 11(2): e023079. https://dx.doi.org/10.1161/ JAHA.121.023079.
Russell M.W. JAHA spotlight on pregnancy and its impact on maternal and offspring cardiovascular health. J. Am. Heart Assoc. 2022; 11(2): e025167. https://dx.doi.org/10.1161/JAHA.121.025167.
Valensise H., Pometti F., Farsetti D., Novelli G.P., Vasapollo B. Hemodynamic assessment in patients with preterm premature rupture of the membranes (pPROM). Eur. J. Obstet. Gynecol. Reprod. Biol. 2022; 274: 1‑4. https://dx.doi.org/10.1016/j.ejogrb.2022.04.027.
Harville E.W., Crook C.E., Bazzano L.A., Woo J.G., Burns T.L., Raitakari O. et al. Cardiovascular risk factors before and during pregnancy: Does pregnancy unmask or initiate risk? J. Obstet. Gynaecol. Res. 2021; 47(11): 3849‑56. https://dx.doi.org/10.1111/jog.14971.
Retnakaran R., Shah B.R. The adverse cardiovascular risk factor profile of women with pre‑eclampsia develops over time in the years before pregnancy. BJOG. 2022; 129(9): 1512‑20. https://dx.doi.org/10.1111/ 1471‑0528.17084.
Retnakaran R., Shah B.R. Patterns of cardiovascular risk factors in the years before pregnancy in nulliparous women with and without preterm birth and small‑for‑gestational‑Age Delivery. J. Am. Heart Assoc. 2021; 10(12): e021321. https://dx.doi.org/10.1161/JAHA.121.021321.
Cain M.A., Salemi J.L., Tanner J.P., Kirby R.S., Salihu H.M., Louis J.M. Pregnancy as a window to future health: maternal placental syndromes and short‑term cardiovascular outcomes. Am. J. Obstet. Gynecol. 2016; 215(4): 484. e1‑484.e14. https://dx.doi.org/10.1016/j.ajog.2016.05.047.
Catov J.M., Margerison-Zilko C. Pregnancy as a window to future health: short‑term costs and consequences. Am. J. Obstet. Gynecol. 2016; 215(4): 406‑7. https://dx.doi.org/10.1016/j.ajog.2016.06.060.
Lewey J., Levine L.D., Yang L., Triebwasser J.E., Groeneveld P.W. Patterns of postpartum ambulatory care follow‑up care among women with hypertensive disorders of pregnancy. J. Am. Heart Assoc. 2020; 9(17): e016357. https://dx.doi.org/10.1161/JAHA.120.016357.
Choi E., Kazzi B., Varma B., Ortengren A.R., Minhas A.S., Vaught A.J. et al. The fourth trimester: a time for enhancing transitions in cardiovascular care. Curr. Cardiovasc. Risk Rep. 2022; 16(12): 219‑29. https://dx.doi.org/10.1007/ s12170‑022‑00706‑x.
Morgan J., Bauer S., Whitsel A., Combs C.A.; Patient Safety and Quality Committee. Society for Maternal‑Fetal Medicine Special Statement: Postpartum visit checklists for normal pregnancy and complicated pregnancy. Am. J. Obstet. Gynecol. 2022; 227(4): B2‑B8. https://dx.doi.org/10.1016/j.ajog.2022.06.007.
Saei Ghare Naz M., Sheidaei A., Aflatounian A., Azizi F., Ramezani Tehrani F. Does adding adverse pregnancy outcomes improve the framingham cardiovascular risk score in women? Data from the Tehran lipid and glucose study. J. Am. Heart Assoc. 2022; 11(2): e022349. https://dx.doi.org/10.1161/ JAHA.121.022349.
Arnett D.K., Blumenthal R.S., Albert M.A., Buroker A.B., Goldberger Z.D., Hahn E.J. et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: A Report of the American College of Cardiology/ American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019; 140(11): e596‑e646. https://dx.doi.org/10.1161/ CIR.0000000000000678.
Parikh N.I., Gonzalez J.M., Anderson C.A.M., Judd S.E., Rexrode K.M., Hlatky M.A. et al. Adverse pregnancy outcomes and cardiovascular disease risk: unique opportunities for cardiovascular disease prevention in women: A Scientific Statement From the American Heart Association. Circulation. 2021; 143(18): e902‑e916. https://dx.doi.org/10.1161/CIR.0000000000000961.
Brown H.L., Smith G.N. Pregnancy complications, cardiovascular risk factors, and future heart disease. Obstet. Gynecol. Clin. North Am. 2020; 47(3): 487‑95. https://dx.doi.org/10.1016/j.ogc.2020.04.009.
Murray Horwitz M.E., Fisher M.A., Prifti C.A., Rich-Edwards J.W., Yarrington C.D., White K.O. et al. Primary care‑based cardiovascular disease risk management after adverse pregnancy outcomes: a narrative review. J. Gen. Intern. Med. 2022; 37(4): 912‑21. https://dx.doi.org/10.1007/ s11606‑021‑07149‑x.

Received 30.11.2022

Accepted 24.03.2023

Nariman R. Akhmadeyev, Ph.D., Associate Professor, Department of Obstetrics and Gynecology named after Prof. V.S. Gruzdev, Kazan State Medical University, Ministry of Health of Russian Federation; Head of Labor Department No.1, City Clinical Hospital No.16, Kazan, +7(919)690-39-57, akhmadeyevnr@gmail.com, https://orcid.org/0000-0003-0908-7256, 420012, Russian Federation, Kazan, Butlerova str., 49.
Ildar F. Fatkullin, Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology named after Prof. V.S. Gruzdev, Kazan State Medical University, Ministry of Health of Russian Federation, +7(960)048-01-04, fatkullin@yandex.ru, https://orcid.org/0000-0001-9673-9077, 420012, Russian Federation, Kazan, Butlerova str., 49.
Larisa S. Fatkullina, Ph.D., Associate Professor, Department of Obstetrics and Gynecology named after Prof. V.S. Gruzdev, Kazan State Medical University, Ministry of Health of Russian Federation; Chief Freelance Specialist in Obstetrics and Gynecology of Kazan Department of Health of Ministry of Health of the Republic of Tatarstan, +7(953)405-67-47, fatkullinalara@gmail.com, https://orcid.org/0000-0003-0361-2785, 420012, Russian Federation, Kazan, Butlerova str., 49.

Cardiovascular consequences of great obstetrical syndromes

Akhmadeev N.R., Fatkullin I.F., Fatkullina L.S.

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