Sammendrag
Objectives: To review the literature about preeclampsia and other placenta related disorders in relation to future maternal cardiovascular health, and secondly propose a possible follow-up strategy. Material and Methods: This student project used a non-systematic literature research in PubMed and in McMaster PLUS. Articles were selected in agreement with my supervisor Professor Annetine Staff, who also supplied me with some clinical guidelines and additional reviews and studies. Search terms included placenta, preeclampsia (HELLP/eclampsia), fetal growth restriction, intrauterine/fetal growth restriction/retardation, SGA (small for gestational age), placental insufficiency, abruption placenta , combined with the keywords CVD, stroke, atherosclerosis, myocardial infarction, hypertension, cerebrovascular disease . Another search also included the keywords acute atherosis and CVD . Results: Preeclampsia and other placenta related pregnancy complications increase the risk of subsequent coronary heart disease, stroke and CVD in general (risk estimates between 1.3 to 3.3). The association is further increased with the severity of preeclampsia. Preeclampsia combined with preterm birth, IUGR, fetal death or recurrent disease increases the risk to 2.8-8.1, compared with the risk of women with uncomplicated pregnancies. Also there seems to be a dose-response relationship between the CVD risk and recurrent preeclampsia: the risk increases with recurrence. Conclusions: Women experiencing preeclampsia and other placenta related pregnancy complications have a substantially increased risk of future cardiovascular disease. At present, there is no agreed follow-up program of these women after pregnancy. This student project proposes a Flow Chart with follow-up preventive measures in order to reduce the risk and burden of long-term CVD among these parous women with elevated CVD risk. The author of this student project proposes the group of parous women affected by early onset or recurrent preeclampsia to be offered an intensified long-term follow-up and assessment.