Miss Claire Shi, Associate Professor George Mangos2,3,4, Dr Lynne Roberts2,3, Professor Mark Brown3,4, Dr Franziska Pettit3,4, Professor Anthony O'Sullivan3,5, Associate Professor Gregory Davis1,2, Associate Professor Amanda Henry1,2,3
1Discipline of Women’s Health, School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Sydney, Australia, 2Department of Women’s and Children’s Health, St. George Hospital, Sydney, Australia , 3St. George and Sutherland Clinical Campus, School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Sydney, Australia, 4Department of Renal Medicine, St George Hospital, Sydney, Australia, 5Department of Endocrinology, St George Hospital, Sydney, Australia
Biography:
Claire is a 5th year medical student at UNSW. She did her honours research project under the Obstetric Medicine Research Group at St George Hospital, Sydney.
Abstract:
Background and aims: Following preeclampsia (PE), women have a lifelong increased risk of cardiovascular disease. This study aims to 1) compare blood pressure (BP) and other cardiovascular markers 5 years postpartum between women who experienced PE versus those after normotensive pregnancy (NP) and 2) examine longitudinal trends in PE and NP groups at 6 months, 2 years, and 5 years postpartum.
Methods: This is five-year data from the prospective cohort Postpartum Physiology, Psychology and Paediatric follow-up study (P4) with women at a metropolitan Australian hospital studied at 6 months, 2 years and 5 years after PE or NP. Measures taken included office BP, 24-hour ambulatory blood pressure monitoring (ABPM), central BP, blood and urine samples.
Results: Included were 171 women after NP and 45 after PE. Five years postpartum, women after PE had higher average office BP (116±11/76±9mmHg vs 105±9/68±7mmHg, p<0.001), 24-hour average BP (114±10/75±8mmHg vs 109±8/69±7 mmHg, p=0.02), and central BP (108±13/75±9mmHg vs 99±10/70±8mmHg, p=0.02) than NP controls. More women with previous PE had developed chronic hypertension (according to 2017 AHA thresholds for Stage 1 hypertension, 130/80 mmHg, 26% vs 6%, p<0.001). Insulin resistance (HOMA-IR score) was higher after PE than NP (2.3±1.8 vs 1.6± 1.1, p<0.001). There were no significant changes over time in BP in either group.
Conclusion: Five years postpartum, women after PE had higher BP, increased rates of hypertension by 2017 AHA guidelines and higher HOMA-IR than after NP. These early changes in cardiovascular risk factors, persistently present 6 months to 5 years postpartum, likely contribute to women’s increased cardiovascular disease rates following PE and underscore the importance of postpartum follow-up and intervention after PE.
Keywords
Preeclampsia, Cardiovascular Risk, Hypertension
References
Davis GK, Roberts L, Mangos G, Henry A, Pettit F, O’Sullivan A, et al. Postpartum physiology, psychology and paediatric follow up study (P4 Study) – Study protocol. Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health. 2016 Oct;6(4):374–9.
Henry A, Mangos G, Roberts LM, Brown MA, Pettit F, O’Sullivan AJ, et al. Preeclampsia-Associated Cardiovascular Risk Factors 6 Months and 2 Years After Pregnancy: The P4 Study. Hypertension. 2024 Apr 1;81(4):851–60.