Women with pre-eclampsia are more likely to suffer a heart attack or stroke than their peers within seven years of delivery.
Researchers from the University of Copenhagen say that the risk of heart attack and stroke after pre-eclampsia can remain elevated for over 20 years. The full findings of the study have been published 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 Dr 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 programmes,” she added.
Pre-eclampsia can be hard to identify
A total of 8% of pregnancies are affected by pre-eclampsia worldwide. Signs of the condition are high blood pressure and protein in the urine. These symptoms usually develop after 20 weeks of pregnancy or shortly after the delivery. Symptoms include severe headaches, nausea, and stomach pain.
“Women may mistake these for ‘normal’ pregnancy symptoms and thus not seek medical help until the condition becomes severe. Most cases are mild, but pre-eclampsia may lead to serious complications for the mother and baby if not treated in time,” explained said Dr Hallum.
It is well known that pre-eclampsia leads to an elevated risk of cardiovascular disease in women in later life. However, this study was the first to determine how soon after pregnancy these heart attacks and strokes occur and the rate of risk in different age groups.
The researchers used national registers to identify all pregnant women in Denmark between 1978 and 2017. The women were grouped into those with one or more pregnancies complicated by pre-eclampsia and those with no pre-eclampsia. Each participant was free of cardiovascular disease before pregnancy and was monitored for heart attack and stroke for a maximum of 39 years.
“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,” said Dr Hallum.
The risk of heart attack and stroke is long-lasting
A total of 1,157,666 women were included in the study. Of those with pre-eclampsia in their first pregnancy, around 2% had a heart attack or stroke within two decades of delivery, compared with up to 1.2% in women without pre-eclampsia.
“A 2% incidence of acute myocardial infarction and ischaemic 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),” stated the paper.
The researchers found that women with pre-eclampsia were four times more likely to have a heart attack and three times more likely to have a stroke within ten years of delivery. The risk of heart attack or stroke was remained twice as high in the pre-eclampsia group after more than 20 years of giving birth compared to unaffected women.
The researchers found that women aged 30 to 39 years with a history of pre-eclampsia were five and three times more likely to have a heart attack and stroke, respectively.
The increased risk in those with a history of pre-eclampsia persisted throughout adulthood. Women over the age of 50 were at double the risk compared to their peers with no history of the condition.
“Women are often in contact with the healthcare system during and immediately after pregnancy, providing a window of opportunity to identify those at increased risk of cardiovascular disease. The number of women with previous pre-eclampsia is large, and routine follow-up could last years or even decades. Our study suggests that the women most likely to benefit from screening are those who had pre-eclampsia after age 35 and those who had it more than once. Prevention should start within a decade of delivery, for example by treating high blood pressure and informing women about risk factors for heart disease such as smoking and inactivity,” concluded Dr Hallum.