Faculty of Medicine, University of Oslo, PB 1171, Blindern, 0381 Oslo, Norway; Division of Obstetrics and Gynaecology, Oslo University Hospital, PB 4956 Nydalen, 0424 Oslo, Norway.
Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas/SP, Brazil.
Pregnancy Hypertens. 2024 Jun;36:101127. doi: 10.1016/j.preghy.2024.101127. Epub 2024 Apr 21.
Cardiovascular disease (CVD) is globally the leading cause of death and disability. Sex-specific causes of female CVD are under-investigated. Pregnancy remains an underinvestigated sex-specific stress test for future CVD and a hitherto missed opportunity to initiate prevention of CVD at a young age. Population-based studies show a strong association between female CVD and hypertensive disorders of pregnancy. This association is also present after other pregnancy complications that are associated with placental dysfunction, including fetal growth restriction, preterm delivery and gestational diabetes mellitus. Few women are, however, offered systematic cardio-preventive follow-up after such pregnancy complications. These women typically seek help from the health system at first clinical symptom of CVD, which may be decades later. By this time, morbidity is established and years of preventive opportunities have been missed out. Early identification of modifiable risk factors starting postpartum followed by systematic preventive measures could improve maternal cardiovascular health trajectories, promoting healthier societies. In this non-systematic review we briefly summarize the epidemiological associations and pathophysiological hypotheses for the associations. We summarize current clinical follow-up strategies, including some proposed by international and national guidelines as well as user support groups. We address modifiable factors that may be underexploited in the postpartum period, including breastfeeding and blood pressure management. We suggest a way forward and discuss the remaining knowledge gaps and barriers for securing the best evidence-based follow-up, relative to available resources after a hypertensive pregnancy complication in order to prevent or delay onset of premature CVD.
心血管疾病（CVD）是全球范围内导致死亡和残疾的主要原因。女性 CVD 的特定性别原因研究不足。妊娠仍然是未来 CVD 的一个研究不足的特定性别应激测试，也是在年轻时开始预防 CVD 的一个错失的机会。基于人群的研究表明，女性 CVD 与妊娠高血压疾病之间存在强烈关联。这种关联在与胎盘功能障碍相关的其他妊娠并发症（包括胎儿生长受限、早产和妊娠期糖尿病）后也存在。然而，很少有女性在经历此类妊娠并发症后接受系统的心血管预防随访。这些女性通常在首次出现 CVD 的临床症状时才会向医疗系统寻求帮助，而此时可能已经过去了几十年。此时，发病率已经确定，错过了多年的预防机会。产后早期识别可改变的危险因素，并随后采取系统的预防措施，可以改善产妇的心血管健康轨迹，促进更健康的社会。在本次非系统性综述中，我们简要总结了流行病学关联和与这些关联相关的病理生理学假设。我们总结了目前的临床随访策略，包括国际和国家指南以及用户支持团体提出的一些策略。我们讨论了在产后期间可能未被充分利用的可改变因素，包括母乳喂养和血压管理。我们提出了一种前进的方式，并讨论了在经历妊娠高血压并发症后，为了预防或延迟早发性 CVD 的发生，根据可用资源确保最佳循证随访的剩余知识差距和障碍。
