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Review
. 2023 Feb;25(2):77-87.
doi: 10.1007/s11886-022-01830-1. Epub 2023 Feb 6.

Markers of Cardiovascular Risk Associated with Pregnancy

Odayme Quesada  1   2 , Dawn C Scantlebury  3   4 , Joan E Briller  5 , Erin D Michos  6 , Niti R Aggarwal  7
Affiliations
Review

Markers of Cardiovascular Risk Associated with Pregnancy

Odayme Quesada et al. Curr Cardiol Rep. 2023 Feb.

Abstract

Purpose of review: The purpose of the review is to summarize the unique cardiovascular disease (CVD) risk factors encountered during pregnancy and to provide the reader with a framework for acquiring a comprehensive obstetric history during the cardiovascular (CV) assessment of women.

Recent findings: Individuals with a history of pregnancies complicated by hypertensive disorders of pregnancy (HDP), gestational diabetes (GDM), preterm delivery, low birth weight, and fetal growth restriction during pregnancy are at a higher risk of developing short- and long-term CV complications compared to those without adverse pregnancy outcomes (APOs). Women with a history of APOs can be at increased risk of CVD even after achieving normoglycemia and normal blood pressure control postpartum. Risk assessment and stratification in women must account for these APOs as recommended by the 2019 American College of Cardiology (ACC)/American Heart Association (AHA) guideline on the primary prevention of CVD. Early recognition, monitoring, and treatment of APOs are key to limiting CVD complications late in maternal life. Recognition of APOs as female-specific cardiovascular risk factors is critical for risk stratification for women and birthing persons. Further research is needed to understand the complex interplay between genetics, environmental, behavioral, and maternal vascular health, and the association between APOs and CVD risk.

Trial registration: ClinicalTrials.gov NCT05180773.

Keywords: CardioObstetrics; Gestational diabetes; Hypertensive disorders of pregnancy; Preclampsia; Pregnancy; Women cardiac risk.

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Figures

Fig. 1
Fig. 1
Traditional and emerging risk factors in women. Many traditional risk factors for ischemic heart disease in women impart a differential risk for women compared with men. The role of emerging nontraditional cardiac risks unique to or predominant in women is also being increasingly recognized. BP indicates blood pressure; DM, diabetes mellitus; HDL, high-density lipoprotein; HTN, hypertension; IHD, ischemic heart disease; LDL, low-density lipoprotein; MI, myocardial infarction; SLE, systemic lupus erythematosus; TG, triglycerides. Adapted with permission [31]
Fig. 2
Fig. 2
Hypertensive disorders of pregnancy. BP indicates blood pressure; HTN, hypertension; LFTs, liver function tests; Pulm, pulmonary; wks, weeks. Reproduced with permission [101]
Fig. 3
Fig. 3
Maternal pathophysiologic mechanisms resulting in adverse pregnancy outcomes, fetal outcomes, and maternal chronic diseases. ASCVD indicates atherosclerotic cardiovascular disease; CV, cardiovascular; CVD, cardiovascular disease
Fig. 4
Fig. 4
Recommended risk assessment tools for improved risk stratification in the postpartum period. BP indicates blood pressure; cor, coronary; Hgb A1C, hemoglobin A1C
See this image and copyright information in PMC

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