Do all women after hypertensive diseases of pregnancy have the same long-term risk of cardiovascular disease in later life?

Abstract

During pregnancy, most maternal organ systems increase in function or size. This is indeed also the case for cardiovascular function and maternal hemodynamics. Most systems show enormous changes that put a serious strain on these systems. Gestational complications develop when an organ system is unable to meet the increased physiological demands of pregnancy. Pregnancy can be considered as the ultimate stress test for these organ systems. Preeclampsia and gestational hypertension may be considered as a derangement of the hemodynamic and cardiovascular system during pregnancy. During later life the hemodynamic and cardiovascular system again derails when aging has its toll. Cardiovascular morbidity and mortality are greatly increased after pregnancies complicated by hypertensive disorders of pregnancy. These complications must be acknowledged by health care providers as a risk factor for later cardiovascular disease. All women after HDP should be followed scrutinous at least during the first 5–10 years after their deliveries. The focus of the follow-up should be on the development of hypertension. Women with an increased risk are those with early-onset preeclampsia, recurrent preeclampsia and preeclampsia in the last pregnancy. Uncomplicated pregnancies after pregnancies complicated by HDP improve the prognosis substantially. Multiplet pregnancies with HDP tend to have lower risks for CVD in later life than singleton pregnancies with HDP.