Department of Medicine (S.S.K., N.A.C.), Northwestern University Feinberg School of Medicine, Chicago, IL.
Department of Preventive Medicine (S.S.K.), Northwestern University Feinberg School of Medicine, Chicago, IL.
Circ Res. 2023 Jun 9;132(12):1584-1606. doi: 10.1161/CIRCRESAHA.123.322001. Epub 2023 Jun 8.
Pregnancy is commonly referred to as a window into future CVH (cardiovascular health). During pregnancy, physiological adaptations occur to promote the optimal growth and development of the fetus. However, in approximately 20% of pregnant individuals, these perturbations result in cardiovascular and metabolic complications, which include hypertensive disorders of pregnancy, gestational diabetes, preterm birth, and small-for-gestational age infant. The biological processes that lead to adverse pregnancy outcomes begin before pregnancy with higher risk of adverse pregnancy outcomes observed among those with poor prepregnancy CVH. Individuals who experience adverse pregnancy outcomes are also at higher risk of subsequent development of cardiovascular disease, which is largely explained by the interim development of traditional risk factors, such as hypertension and diabetes. Therefore, the peripartum period, which includes the period before (prepregnancy), during, and after pregnancy (postpartum), represents an early cardiovascular moment or window of opportunity when CVH should be measured, monitored, and modified (if needed). However, it remains unclear whether adverse pregnancy outcomes reflect latent risk for cardiovascular disease that is unmasked in pregnancy or if adverse pregnancy outcomes are themselves an independent and causal risk factor for future cardiovascular disease. Understanding the pathophysiologic mechanisms and pathways linking prepregnancy CVH, adverse pregnancy outcomes, and cardiovascular disease are necessary to develop strategies tailored for each stage in the peripartum period. Emerging evidence suggests the utility of subclinical cardiovascular disease screening with biomarkers (eg, natriuretic peptides) or imaging (eg, computed tomography for coronary artery calcium or echocardiography for adverse cardiac remodeling) to identify risk-enriched postpartum populations and target for more intensive strategies with health behavior interventions or pharmacological treatments. However, evidence-based guidelines focused on adults with a history of adverse pregnancy outcomes are needed to prioritize the prevention of cardiovascular disease during the reproductive years and beyond.
妊娠通常被视为未来心血管健康 (CVH) 的窗口。在妊娠期间，会发生生理适应以促进胎儿的最佳生长和发育。然而，在大约 20%的孕妇中，这些变化会导致心血管和代谢并发症，包括妊娠高血压疾病、妊娠期糖尿病、早产和小于胎龄儿。导致不良妊娠结局的生物学过程在妊娠前就已经开始，那些孕前 CVH 较差的人不良妊娠结局的风险更高。经历不良妊娠结局的个体也有更高的风险随后发展为心血管疾病，这在很大程度上可以用传统风险因素（如高血压和糖尿病）的中期发展来解释。因此，围产期包括妊娠前（孕前）、期间和之后（产后），代表了一个早期的心血管时刻或机会之窗，在此期间应测量、监测和调整（如有必要）CVH。然而，目前尚不清楚不良妊娠结局是否反映了妊娠期间暴露的心血管疾病潜在风险，还是不良妊娠结局本身就是未来心血管疾病的独立和因果风险因素。了解将孕前 CVH、不良妊娠结局和心血管疾病联系起来的病理生理机制和途径，对于制定针对围产期各个阶段的策略是必要的。新出现的证据表明，使用生物标志物（例如利钠肽）或影像学（例如冠状动脉钙计算机断层扫描或超声心动图评估不良心脏重构）进行亚临床心血管疾病筛查的效用，以识别风险丰富的产后人群，并针对更密集的策略进行干预，例如健康行为干预或药物治疗。然而，需要针对有不良妊娠结局史的成年人制定基于证据的指南，以优先在生殖期及以后预防心血管疾病。
