Decreased flow-mediated dilation is present 1 year after a pre-eclamptic pregnancy

Pre-eclamptic toxaemia is associated with inflammation and vascular endothelial dysfunction. As women who have had pre-eclamptic toxaemia are at an increased risk of cardiovascular disease, we hypothesized that these abnormalities are persistent.

Eighteen women with a history of pre-eclamptic toxaemia and 17 age-matched controls were enrolled. All underwent non-invasive ultrasound examination of the brachial artery for an evaluation of flow-mediated vasodilatation (FMD). The ambulatory blood pressure measurement (ABPM), and plasma concentrations of lipoproteins, inflammation markers, adhesion molecules, glucometabolic and haemostatic factors were determined.

Women with a history of pre-eclamptic toxaemia had lower FMD compared with controls (2.5 +/- 2.9 versus 10.3 +/- 2.0%, P < 0.0001). ABPM showed higher systolic, diastolic and mean arterial blood pressures during daytime in the pre-eclamptic toxaemia group than in controls (123 +/- 9, 81 +/- 6 and 95 +/- 6 mmHg versus 116 +/- 9, 76 +/- 7 and 90 +/- 7 mmHg, respectively, all P < 0.05). Among the biochemical determinations, a high value of the homeostasis model assessment of insulin resistance was calculated at 1.3 (1.1-2.1) median [interquartile range (IQR)] in the pre-eclamptic toxaemia group and 1.0 (0.7-1.3) in controls (P < 0.01), and when adjusted for body mass index there was still a significant difference between groups (P < 0.05). No significant differences were found for other metabolic and haemostatic factors.

Women with a previous history of pre-eclamptic toxaemia have decreased FMD compared with women with a previous normal pregnancy. This perturbation is a proof of an abnormal state still present 1 year after delivery.