Department of Internal Medicine, Geisinger Medical Center, Danville, PA, United States.
Department of Cardiology, Geisinger Medical Center, Danville, PA, United States.
Eur J Intern Med. 2018 Nov;57:1-6. doi: 10.1016/j.ejim.2018.07.020. Epub 2018 Jul 25.
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.
妊娠相关并发症表明存在动脉粥样硬化疾病的倾向。流行病学数据表明，有妊娠丢失、早产或宫内生长受限病史的女性会较早出现心血管疾病。妊娠糖尿病后，早发糖尿病、心肌梗死发生率增加和中风发生率增加更为普遍。此外，妊娠高血压疾病标志着显著的病理生理变化，包括血管功能障碍和免疫变化，这些变化会导致动脉粥样硬化，并导致中风、缺血性心脏病和心脏死亡率的大幅增加。代谢、内皮和炎症变化是经历复杂妊娠的患者发生心血管疾病倾向的早期或早期识别的原因。因此，美国心脏协会指南将妊娠相关并发症视为心脏病的独立危险因素。本综述告知医生有关流行病学数据和指南建议的信息，旨在指导医生进行早期干预，包括提供者教育、产后多学科（初级保健、产科、心脏病学）评估、危险因素监测和复杂妊娠后的控制。
