Abstract
Background:
It is well established that hypertensive disorders of pregnancy (HDP) are associated with an increased risk of cardiovascular disease (CVD) in later life. National and International guidelines recognize this but due to a lack of research in this area few details are provided on how best to risk stratify or when and how to monitor these women.
Objectives:
This article aims to summarise current guidelines in this area in order to raise awareness of need for further research in this important clinical area.
Search strategy:
A review of the published literature was carried out in August 2018 using the databases EMBASE and Medline and the websites of professional societies were searched manually using the search terms ‘pre-eclampsia’, ‘hypertensive disorders of pregnancy’, ‘management’, ‘guidelines’, ‘long term follow up’ and ‘cardiovascular risk’. Guidelines published in English were included and articles that provided guidance on follow up post-partum of women with HDP.
Main results:
The search identified 360 records. Of these, 16 guidelines mentioned the follow up of women with HDP; their reported years ranges from 2010 to 2018. Only 8 (50%) provided some level of recommendation for follow up beyond the immediate post-partum period. These recognised the future risk of CVD to women from HDP and provide detailed recommendations for the management of these conditions during pregnancy and in the immediate post-partum period. Guidelines recommended that women and primary care clinicians are made aware of this risk and some suggest yearly BP monitoring, and at least 5 yearly monitoring of renal functions, urinalysis and lipid profile testing alongside lifestyle modifications and control of CVD risk factors. Guidelines used a combination of meta analysis, individual cohort studies and expert opinions to inform their recommendations.
Conclusions:
There is a need for future studies of women with a history of HDP to define their trajectory for the development of CVD and candidate biomarkers in order to develop screening, risk stratification, and preventive measures to reduce the significant CV burden associated with HDP in women.
It is well established that hypertensive disorders of pregnancy (HDP) are associated with an increased risk of cardiovascular disease (CVD) in later life. National and International guidelines recognize this but due to a lack of research in this area few details are provided on how best to risk stratify or when and how to monitor these women.
Objectives:
This article aims to summarise current guidelines in this area in order to raise awareness of need for further research in this important clinical area.
Search strategy:
A review of the published literature was carried out in August 2018 using the databases EMBASE and Medline and the websites of professional societies were searched manually using the search terms ‘pre-eclampsia’, ‘hypertensive disorders of pregnancy’, ‘management’, ‘guidelines’, ‘long term follow up’ and ‘cardiovascular risk’. Guidelines published in English were included and articles that provided guidance on follow up post-partum of women with HDP.
Main results:
The search identified 360 records. Of these, 16 guidelines mentioned the follow up of women with HDP; their reported years ranges from 2010 to 2018. Only 8 (50%) provided some level of recommendation for follow up beyond the immediate post-partum period. These recognised the future risk of CVD to women from HDP and provide detailed recommendations for the management of these conditions during pregnancy and in the immediate post-partum period. Guidelines recommended that women and primary care clinicians are made aware of this risk and some suggest yearly BP monitoring, and at least 5 yearly monitoring of renal functions, urinalysis and lipid profile testing alongside lifestyle modifications and control of CVD risk factors. Guidelines used a combination of meta analysis, individual cohort studies and expert opinions to inform their recommendations.
Conclusions:
There is a need for future studies of women with a history of HDP to define their trajectory for the development of CVD and candidate biomarkers in order to develop screening, risk stratification, and preventive measures to reduce the significant CV burden associated with HDP in women.
| Original language | English |
|---|---|
| Article number | 55 |
| Number of pages | 11 |
| Journal | Frontiers in cardiovascular medicine |
| Volume | 6 |
| Early online date | 9 May 2019 |
| DOIs | |
| Publication status | Published - 17 May 2019 |
Keywords
- pre-eclampsia
- hypertensive disorder of pregnancy
- guidelines
- cardiovascular disease
- cardiovascular disease in women
Access to Document
- Hypertensive Disorders of Pregnancy and Subsequent Cardiovascular Disease: Current National and International Guidelines and the Need for Future Research
© 2019 Gamble, Brikinns, Myint and Bhattacharya. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. https://creativecommons.org/licenses/by/4.0/