Am J Perinatol 2019; 36(08): 806-811
DOI: 10.1055/s-0038-1675374
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Effects of Preeclampsia on Maternal and Pediatric Health at 11 Years Postpartum

Stephanie E. Chan
1   Department of Obstetrics and Gynecology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
,
Jessica Pudwell
1   Department of Obstetrics and Gynecology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
,
Graeme N. Smith
1   Department of Obstetrics and Gynecology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
› Institutsangaben
Weitere Informationen

Publikationsverlauf

23. April 2018

14. September 2018

Publikationsdatum:
31. Oktober 2018 (online)

Abstract

Objective To determine the association of preeclampsia (PE) with the presence of cardiovascular risk (CVR) factors at approximately 11 years postpartum and to assess the longer term effect of PE on childhood development.

Study Design A mail-out survey was sent to all women who were previously recruited into the Kingston arm of the Pre-Eclampsia New Emerging Team's prospective cohort (n = 112 PE and n = 150 control). Physical and biochemical CVR markers were compared between the two groups. Physical, social, and cognitive development of the children involved in the pregnancies was evaluated using the Vineland-3 Domain-Level Parent/Caregiver Form.

Results Thirteen PE women and 28 control women returned the study questionnaire. Based on the 2017 American Heart Association High Blood Pressure Clinical Practice Guidelines, 9/13 (69.2%) of the PE women, compared with 6/28 (21.4%) of the control women, have hypertension (p < 0.01). The median percentile rank for overall adaptive functioning was 58 (interquartile range [IQR: 21–73]) in the PE children and 81 (IQR: 61–94) in the control children (p < 0.05).

Conclusion The development of PE leads to longer term changes in CVR markers and in childhood development at approximately 11 years postpartum. Pregnancy and the postpartum provide an early window of opportunity for early maternal and child screening and intervention for health preservation and disease prevention.

 
  • References

  • 1 Williams D. Pregnancy: a stress test for life. Curr Opin Obstet Gynecol 2003; 15 (06) 465-471
  • 2 Smith GC, Pell JP, Walsh D. Pregnancy complications and maternal risk of ischaemic heart disease: a retrospective cohort study of 129,290 births. Lancet 2001; 357 (9273): 2002-2006
  • 3 Ray JG, Vermeulen MJ, Schull MJ, Redelmeier DA. Cardiovascular health after maternal placental syndromes (CHAMPS): population-based retrospective cohort study. Lancet 2005; 366 (9499): 1797-1803
  • 4 Funai EF, Paltiel OB, Malaspina D, Friedlander Y, Deutsch L, Harlap S. Risk factors for pre-eclampsia in nulliparous and parous women: the Jerusalem perinatal study. Paediatr Perinat Epidemiol 2005; 19 (01) 59-68
  • 5 Roberts JM, Lain KY. Recent insights into the pathogenesis of pre-eclampsia. Placenta 2002; 23 (05) 359-372
  • 6 Roberts JM, Hubel CA. The two stage model of preeclampsia: variations on the theme. Placenta 2009; 30 (Suppl A): S32-S37
  • 7 Bellamy L, Casas J-P, Hingorani AD, Williams DJ. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ 2007; 335 (7627): 974
  • 8 Magnussen EB, Vatten LJ, Lund-Nilsen TI, Salvesen KÅ, Davey Smith G, Romundstad PR. Prepregnancy cardiovascular risk factors as predictors of pre-eclampsia: population based cohort study. BMJ 2007; 335 (7627): 978
  • 9 Irgens HU, Reisaeter L, Irgens LM, Lie RT. Long term mortality of mothers and fathers after pre-eclampsia: population based cohort study. BMJ 2001; 323 (7323): 1213-1217
  • 10 Smith GN, Walker MC, Liu A. , et al; Pre-Eclampsia New Emerging Team (PE-NET). A history of preeclampsia identifies women who have underlying cardiovascular risk factors. Am J Obstet Gynecol 2009; 200 (01) 58.e1-58 .e8
  • 11 Smith GN, Pudwell J, Walker M, Wen S-W. Ten-year, thirty-year, and lifetime cardiovascular disease risk estimates following a pregnancy complicated by preeclampsia. J Obstet Gynaecol Can 2012; 34 (09) 830-835
  • 12 Whelton PK, Carey RM, Aronow WS. , et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2018; 71 (06) 1269-1324
  • 13 D'Agostino Sr RB, Vasan RS, Pencina MJ. , et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation 2008; 117 (06) 743-753
  • 14 Pencina MJ, D'Agostino Sr RB, Larson MG, Massaro JM, Vasan RS. Predicting the 30-year risk of cardiovascular disease: the Framingham Heart Study. Circulation 2009; 119 (24) 3078-3084
  • 15 Smith GN, Pudwell J, Walker M, Wen S-W. Risk estimation of metabolic syndrome at one and three years after a pregnancy complicated by preeclampsia. J Obstet Gynaecol Can 2012; 34 (09) 836-841
  • 16 Sparrow S, Cicchetti D, Saulnier C. . Vineland Adaptive Behavior Scales, 3rd ed. Circle Pines, MN: American Guidance Service; 2016
  • 17 Warshafsky C, Pudwell J, Walker M, Wen S-W, Smith GN. ; Preeclampsia New Emerging Team. Prospective assessment of neurodevelopment in children following a pregnancy complicated by severe pre-eclampsia. BMJ Open 2016; 6 (07) e010884
  • 18 Rätsep MT, Paolozza A, Hickman AF. , et al. Brain structural and vascular anatomy is altered in offspring of pre-eclamptic pregnancies: a pilot study. AJNR Am J Neuroradiol 2016; 37 (05) 939-945
  • 19 Rätsep MT, Hickman AF, Maser B. , et al. Impact of preeclampsia on cognitive function in the offspring. Behav Brain Res 2016; 302: 175-181
  • 20 Smith ER. The Canadian heart health strategy and action plan. Can J Cardiol 2009; 25 (08) 451-452
  • 21 Smith GN. Development of preeclampsia provides a window of opportunity for early cardiovascular risk screening and intervention. Expert Rev Obstet Gynecol 2009; 4 (04) 355-357