Pre-clinical atherosclerosis persists up to 10 years after preeclamptic pregnancy.

 Preeclampsia (PE) is a hypertensive disorder in pregnancy complicating up to 1-5% of pregnancies, and remains a major cause of maternal and fetal morbidity and mortality worldwide.

Pre-eclampsia (PE) is known to be associated with an increased cardiovascular risk later in life. The endothelial dysfunction persists even after the pregnancy is over.  Studies end-stage renal disease (ESRD) have shown that PE confers a subsequent risk of developing Hypertension in a short span of 8 years after delivery.[1] Women who are hypertensive after PE have twice the risk of developing CVD and 5-10-fold risk of developing end-stage renal disease (ESRD) as compared to healthy women.[2]

Identifying these young women with increased risk of CVD and ESRD is of considerable public health importance, since precautionary measures and lifestyle changes can be made to mitigate the risk to some extent.

Current guidelines advocate screening for CVD and renal disease in women with history of Preeclamptic pregnancy, but the evidence is very low.

Researchers have questioned the old dictum that ‘placenta is the cause of PE’ and a new paradigm is emerging that maternal cardiovascular dysfunction is the cause of PE especially the late onset variety. In fact, considerable atherosclerotic burden is already present during the preeclamptic pregnancy and 10 years thereafter. It is increased further by advanced age at first pregnancy, an increasing trend in recent years.

The carotid intima–media thickness (CIMT) is increasingly being used as a measure of preclinical atherosclerosis and can be evaluated by simple USG.

measuring CIMT 

Only a small number of studies have been conducted so far, that investigates the carotid Intima thickness and PE pregnancy.

A systematic review and meta-analysis of studies were conducted that reported CIMT in pregnant women with or without PE. The study was published online January 5, 2017 in Ultrasound in Obstetrics and Gynecology. [3]

A total of 14 studies conducted before March 2016 were identified and included in the meta-analysis. It was seen that women with PE had a significantly higher intima thickness as evident by Standardized mean difference (SMD, 1.10; P < 0.001). The difference persisted even a decade post-delivery.

The CIMT can be measured as a part of cardiovascular screening even before menopause when the CVD risks  rises  sharply for women.

Full Text of the article .

---

[1] https://www.ncbi.nlm.nih.gov/pubmed/28001098

[2] https://www.ncbi.nlm.nih.gov/pubmed/25139045

[3] http://onlinelibrary.wiley.com/doi/10.1002/uog.17367/full