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 The Under-
Risks of
An Editorial by Cardiologist Deirdre Mattina, MD
Preeclampsia affects 2-5% of all pregnancies and is a leading cause of maternal and neonatal morbidity and mortality [Maturitas 82(2015)153-161]. While the cardiology community recognizes cardiovascular disease (CVD) as the leading health threat to women, we have done little to evolve in our practice of early cardiovascular screening and management of lifestyle risk factors. Preeclampsia and eclampsia are established markers of increased risk for future CVD events, yet pregnancy history is rarely elicited during medical encounters outside of the OB/GYN arena. The American Heart Association (AHA)/American Stroke Association (ASA) prevention guidelines recommend that women with a history of preeclampsia be evaluated for chronic hypertension (elevated blood pressure beyond 3 months postpartum) and other CVD risk factors within 6 months to 1 year post-partum. However, implementation of these guidelines has been limited - only 9% of internists and 38% of OB/GYN provide CVD risk reduction counseling to women with a history of preeclampsia [Hypertens Pregnancy 2012;31(1):50-58].
Unfortunately, many young women who experience hypertension in pregnancy
are in a “vulnerable gap” – between the age of 18 and 40yo and only seek healthcare periodically for OB/GYN care (subsequent pregnancies, screening PAP smears) or ER/ urgent care (common colds, orthopedic accidents). Many women will establish care with an internist or family practitioner after the age of 40 since there is more public awareness of cancer society guidelines for screening mammograms, which remain controversial in their scope.. Dr. Nanette Wenger, a pioneer in cardiovascular disease in women, has called this practice of only focusing on the reproductive organs of women, “bikini medicine.” We are slowly growing more comfortable with the notion that women are more than a collection of milk ducts and ovaries and understanding female cardiovascular health risks is tantamount to their survival
The mechanism of how preeclampsia acts as a ‘vascular insult’ is still not clearly understood, but meta-analyses of cohort and case-control studies show that women with preeclampsia have twice the risk of heart disease and stroke [Seminars in Perinatology 39(2015)276-283].The California Child Health and Development Study found that women with preterm (<34 weeks) preeclampsia had a 9.5 fold risk of
 14 Detroit Medical News Third Quarter 2020

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