Doctor checking blood pressure of a pregnant woman who may have hypertension or pre-eclampsia
Credit: Peter Cade/Getty Images

Women who experience pre-eclampsia have a higher risk of heart attack and stroke than their peers within just seven years after delivery. Their risk remains elevated more than 20 years later. This finding came from a study of more than one million pregnant women published this week in the European Journal of Preventive Cardiology.

“The high risk of cardiovascular disease after pre-eclampsia manifests at young ages and early after delivery,” said study author Sara Hallum of the University of Copenhagen, Denmark. “This indicates that interventions to prevent heart attacks and strokes in affected women cannot wait until middle age when they become eligible for conventional cardiovascular screening programs.”

Pre-eclampsia affects up to eight percent of pregnancies worldwide. It features high blood pressure and protein in the urine, which develop after 20 weeks of pregnancy or soon after delivery. Symptoms include severe headache, stomach pain, and nausea. Work is ongoing to determine how best to predict the condition so it can be better managed.

“Women may mistake these for ‘normal’ pregnancy symptoms and thus not seek medical help until the condition becomes severe,” said Hallum. “Most cases are mild, but pre-eclampsia may lead to serious complications for the mother and baby if not treated in time.”

It is well established that pre-eclampsia predisposes women to an elevated likelihood of cardiovascular disease later in life. This study examined how soon after pregnancy these heart attacks and strokes manifest, and the magnitude of risk in different age groups.

The researchers used national registers to identify all pregnant women in Denmark between 1978 and 2017. Women were grouped into those with one or more pregnancies complicated by pre-eclampsia and those with no pre-eclampsia. Participants were free of cardiovascular disease before pregnancy and were followed for a maximum of 39 years for heart attack and stroke.

Hallum said, “This allowed us to evaluate exactly when cardiovascular disease occurs in women with and without pre-eclampsia, and to estimate risk in different age groups and at various durations of follow-up.”

This study included 1,157,666 women. Up to two percent of those with pre-eclampsia in their first pregnancy had a heart attack or stroke within two decades of delivery, compared with up to 1.2% of unaffected women. Differences in risk became apparent seven years after delivery.

“A 2% incidence of acute myocardial infarction and ischemic stroke should not be accepted as the cost of a pregnancy complicated by pre-eclampsia, particularly considering the young age of these women when they fall ill (below 50 years of age),” the authors wrote.

Overall, women with pre-eclampsia were four times more likely to have a heart attack and three times more likely to have a stroke within 10 years of delivery than those without pre-eclampsia. The risk of heart attack or stroke was still twice as high in the pre-eclampsia group more than 20 years after giving birth compared to unaffected women.

When the researchers examined the risk of cardiovascular disease according to age, they found that women aged 30 to 39 years with a history of pre-eclampsia had five- and three-fold higher rates of heart attack and stroke, respectively, than those of similar age with no history of pre-eclampsia.

The raised likelihood of cardiovascular disease in those with a history of pre-eclampsia persisted throughout adulthood, with women over 50 years of age still at doubled risk compared to their peers with no history of the pregnancy complication.

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