It has been widely thought that the effects of hypertension in pregnancy reversed
after delivery and hypertension values returned to their pre-pregnancy level as it
was seen as a disease of short duration in otherwise healthy young women. However,
recent studies have demonstrated that the principal underlying abnormality, endothelial
dysfunction, remains in women who had preeclampsia and that it is this damage that
increases the risk of developing cardiovascular disease (CVD) in later life. The contributions
of hypertension and dyslipidaemia before and during the pregnancy are also important
and contribute to future risk. Serum lipids are complex and change dramatically in
pregnancy. In general there is an increase in most plasma lipid components, notably
triglycerides, total cholesterol and the major particles of HDL and LDL. Aberrations
or exaggerations in this shift (i.e. decrease HDL and a greater increase in LDL) are
associated with poor outcomes of pregnancy such as preeclampsia. Long term cardiovascular
disease is influenced by preeclampsia and in part potentially by the lipid changes
which escalate late in disease. Whether we can influence the risk of preeclampsia
by controlling cardiovascular risk factors preceding or during preeclampsia, or cardiovascular
disease after preeclampsia is yet to be determined. Ultimately, strategies to control
lipid concentrations will only be viable when we understand the safety to the mother
at the time of the pregnancy, and to the foetus both immediately and in the very long
term. Strategies to control blood pressure are well established in the non-pregnant
population, and previous preeclampsia and gestational hypertension should be considered
in any cardiovascular risk profile. Whether control of blood pressure in the pregnancy
per se is of any longer term benefit is also yet to be determined.
Keywords
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Article info
Publication history
Published online: November 22, 2013
Accepted:
October 20,
2013
Received:
September 20,
2013
Identification
Copyright
© 2013 Published by Elsevier Inc.
