Page 13 - Pro-active Management of Women’s Health after Cardiometabolic Complicated Pregnancies

During pregnancy, the maternal body needs to adapt to a fast growing, highly active, new organ: the placenta. To meet its demands, it reversibly presses the maternal body to its metabolic and cardiovascular limits. Women with a good cardiometabolic health will have no problem to handle this pressure. If, however cardiometabolic health is already compromised and fetal demands cannot be met, it will push women beyond their limits into a state of physical ‘overdrive’, leading to cardiometabolic complicated pregnancy (figure 1). Well known phenotypes of cardiovascular complicated pregnancies are preeclampsia and fetal growth restriction. An example of metabolic complicated pregnancy is gestational diabetes mellitus.
In 2002 Sattar and Greer were the first to postulate the hypothesis that pregnancy is a stress-test for cardiometabolic health1 (figure 1.1). If complicated pregnancy occurs, it flags for decreased cardiometabolic health. These women are at increased risk for future cardiometabolic disease. It is unclear whether having had the complicated pregnancy contributes to the increased risk.
Cardiovascular complications of pregnancy
Cardiovascular complications of pregnancy are gestational hypertension, preeclampsia, eclampsia, placental abruption, and fetal growth restriction. For gestational hypertension, preeclampsia and fetal growth restriction an increased risk for future cardiovascular disease has been shown2 3.
Preeclampsia complicates 2-8% of pregnancies4. It is characterized by hypertension and proteinuria above the 20th week of gestation5. Preeclampsia can occur as different phenotypes. Common phenotypes are early (<34 weeks of gestation) or late (>=34 weeks of gestation) onset, with or without HELLP syndrome (hemolysis, elevated liver enzymes and low platelets) and with or
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