Impact of Hypertensive Disorders of Pregnancy on Maternal and Offspring Cardiovascular Health
TL;DR
Evidence on potential pathophysiologic mechanisms including shared genetic, epigenetic programming and persistent immune dysregulation that contribute to the CV risk is reviewed and recommendations on surveillance strategies in mothers and their offspring are made.
Abstract
Hypertensive disorders of pregnancy (HDP) affect 5–10% of pregnancies globally and are a leading cause of maternal and fetal morbidity and mortality. Beyond their acute obstetrics impact, HDP unmask a lifelong cardiovascular (CV) vulnerability in affected women and confer intergenerational risk to their offspring. In this review, we discuss the latest evidence regarding the CV risk profiles following HDP in the mothers and their offspring. In mothers, HDP is associated with a 7.29-fold increased risk of new chronic hypertension (HTN) within 24 months postpartum and long-term risks of heart failure, coronary heart disease and stroke. Offspring exposed carry a 1.5-fold increased risk for adult HTN and increased risks for ischemic heart disease and stroke. We review evidence on potential pathophysiologic mechanisms including shared genetic, epigenetic programming and persistent immune dysregulation that contribute to the CV risk. We make recommendations on surveillance strategies in mothers and their offspring beginning in the immediate postpartum period and for lifelong follow-up. Management strategies of the CV risk factors, using latest guidelines are discussed. We suggest future directions for research and intervention. Integrated maternal-offspring CV care, women-specific risk prediction tools and equity focused research are needed to reduce the intergenerational burden of HDP.