Cardiovascular disease risk unmasked by pregnancy complications

Pregnancy related complications indicate a propensity for atherosclerotic disease. Epidemiologic data demonstrate early onset cardiovascular disease in women with a history of pregnancy loss, preterm pregnancy or pregnancy complicated by intrauterine growth restriction. Early onset diabetes, increased rates of MI and increased rates of stroke are more prevalent after gestational diabetes. In addition, hypertensive disorders of pregnancy mark significant pathophysiologic changes, including vascular dysfunction and immunologic changes, which induce atherogenesis and result in a substantial increase in rates of stroke, ischemic heart disease and cardiac mortality. Metabolic, endothelial and inflammatory changes are responsible for either the early onset or early recognition of cardiovascular disease propensity in patients who experience a complicated pregnancy. Therefore, the American Heart Association guidelines recognize pregnancy related complications as an independent risk factor for heart disease. This review informs physicians of epidemiologic data and, guideline recommendations and is meant to guide physicians in early interventions including provider education, routine post-partum multidisciplinary (primary care, obstetrics, cardiology) evaluation, risk factor monitoring and control after a complicated pregnancy.