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
