Pregnancy as an Early Cardiovascular Moment: Peripartum Cardiovascular Health
Pregnancy is commonly referred to as a window into future CVH (cardiovascular health). During pregnancy, physiological adaptations occur to promote the optimal growth and development of the fetus. However, in approximately 20% of pregnant individuals, these perturbations result in cardiovascular and...
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Published in | Circulation research Vol. 132; no. 12; pp. 1584 - 1606 |
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Main Authors | , , |
Format | Journal Article |
Language | English |
Published |
United States
Lippincott Williams & Wilkins
09.06.2023
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Abstract | Pregnancy is commonly referred to as a window into future CVH (cardiovascular health). During pregnancy, physiological adaptations occur to promote the optimal growth and development of the fetus. However, in approximately 20% of pregnant individuals, these perturbations result in cardiovascular and metabolic complications, which include hypertensive disorders of pregnancy, gestational diabetes, preterm birth, and small-for-gestational age infant. The biological processes that lead to adverse pregnancy outcomes begin before pregnancy with higher risk of adverse pregnancy outcomes observed among those with poor prepregnancy CVH. Individuals who experience adverse pregnancy outcomes are also at higher risk of subsequent development of cardiovascular disease, which is largely explained by the interim development of traditional risk factors, such as hypertension and diabetes. Therefore, the peripartum period, which includes the period before (prepregnancy), during, and after pregnancy (postpartum), represents an early cardiovascular moment or window of opportunity when CVH should be measured, monitored, and modified (if needed). However, it remains unclear whether adverse pregnancy outcomes reflect latent risk for cardiovascular disease that is unmasked in pregnancy or if adverse pregnancy outcomes are themselves an independent and causal risk factor for future cardiovascular disease. Understanding the pathophysiologic mechanisms and pathways linking prepregnancy CVH, adverse pregnancy outcomes, and cardiovascular disease are necessary to develop strategies tailored for each stage in the peripartum period. Emerging evidence suggests the utility of subclinical cardiovascular disease screening with biomarkers (eg, natriuretic peptides) or imaging (eg, computed tomography for coronary artery calcium or echocardiography for adverse cardiac remodeling) to identify risk-enriched postpartum populations and target for more intensive strategies with health behavior interventions or pharmacological treatments. However, evidence-based guidelines focused on adults with a history of adverse pregnancy outcomes are needed to prioritize the prevention of cardiovascular disease during the reproductive years and beyond. |
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AbstractList | Pregnancy is commonly referred to as a “window” into future cardiovascular health. During pregnancy, physiologic adaptations occur to promote the optimal growth and development of the fetus. However, in approximately 20% of pregnant individuals, these perturbations result in cardiovascular and metabolic complications, which include hypertensive disorders of pregnancy, gestational diabetes, preterm birth, and small for gestational age infant. The biological processes that lead to adverse pregnancy outcomes begin before pregnancy with higher risk of adverse pregnancy outcomes observed among those with poor pre-pregnancy cardiovascular health. Individuals who experience adverse pregnancy outcomes are also at higher risk of subsequent development of cardiovascular disease, which is largely explained by the interim development of traditional risk factors, such as hypertension and diabetes. Therefore, the peripartum period, which includes the period before (pre-pregnancy), during, and after pregnancy (postpartum), represents an early cardiovascular moment or “window” of opportunity when cardiovascular health should be measured, monitored, and modified (if needed). However, it remains unclear whether adverse pregnancy outcomes reflect latent risk for cardiovascular disease that is unmasked in pregnancy or if adverse pregnancy outcomes are themselves an independent and causal risk factor for future cardiovascular disease. Understanding the pathophysiologic mechanisms and pathways linking pre-pregnancy cardiovascular health, adverse pregnancy outcomes and cardiovascular disease are necessary to develop strategies tailored for each stage in the peripartum period. Emerging evidence suggests the utility of subclinical cardiovascular disease screening with biomarkers (e.g., natriuretic peptides) or imaging (e.g., computed tomography for coronary artery calcium or echocardiography for adverse cardiac remodeling) to identify risk-enriched postpartum populations and target for more intensive strategies with health behavior interventions or pharmacologic treatments. However, evidence-based guidelines focused on adults with a history of adverse pregnancy outcomes are needed to prioritize the prevention of cardiovascular disease during the reproductive years and beyond. Pregnancy is commonly referred to as a window into future CVH (cardiovascular health). During pregnancy, physiological adaptations occur to promote the optimal growth and development of the fetus. However, in approximately 20% of pregnant individuals, these perturbations result in cardiovascular and metabolic complications, which include hypertensive disorders of pregnancy, gestational diabetes, preterm birth, and small-for-gestational age infant. The biological processes that lead to adverse pregnancy outcomes begin before pregnancy with higher risk of adverse pregnancy outcomes observed among those with poor prepregnancy CVH. Individuals who experience adverse pregnancy outcomes are also at higher risk of subsequent development of cardiovascular disease, which is largely explained by the interim development of traditional risk factors, such as hypertension and diabetes. Therefore, the peripartum period, which includes the period before (prepregnancy), during, and after pregnancy (postpartum), represents an early cardiovascular moment or window of opportunity when CVH should be measured, monitored, and modified (if needed). However, it remains unclear whether adverse pregnancy outcomes reflect latent risk for cardiovascular disease that is unmasked in pregnancy or if adverse pregnancy outcomes are themselves an independent and causal risk factor for future cardiovascular disease. Understanding the pathophysiologic mechanisms and pathways linking prepregnancy CVH, adverse pregnancy outcomes, and cardiovascular disease are necessary to develop strategies tailored for each stage in the peripartum period. Emerging evidence suggests the utility of subclinical cardiovascular disease screening with biomarkers (eg, natriuretic peptides) or imaging (eg, computed tomography for coronary artery calcium or echocardiography for adverse cardiac remodeling) to identify risk-enriched postpartum populations and target for more intensive strategies with health behavior interventions or pharmacological treatments. However, evidence-based guidelines focused on adults with a history of adverse pregnancy outcomes are needed to prioritize the prevention of cardiovascular disease during the reproductive years and beyond. |
Author | Cameron, Natalie A. Khan, Sadiya S. Lindley, Kathryn J. |
AuthorAffiliation | Department of Medicine (S.S.K., N.A.C.), Northwestern University Feinberg School of Medicine, Chicago, IL |
AuthorAffiliation_xml | – name: Department of Medicine (S.S.K., N.A.C.), Northwestern University Feinberg School of Medicine, Chicago, IL – name: 1 Department of Medicine, Northwestern University Feinberg School of Medicine – name: 2 Department of Preventive Medicine, Northwestern University Feinberg School of Medicine – name: 3 Department of Medicine, Vanderbilt University Medical Center – name: 4 Department of Obstetrics and Gynecology, Vanderbilt University Medical Center |
Author_xml | – sequence: 1 givenname: Sadiya S. surname: Khan fullname: Khan, Sadiya S. organization: Department of Medicine (S.S.K., N.A.C.), Northwestern University Feinberg School of Medicine, Chicago, IL – sequence: 2 givenname: Natalie A. surname: Cameron fullname: Cameron, Natalie A. organization: Department of Medicine (S.S.K., N.A.C.), Northwestern University Feinberg School of Medicine, Chicago, IL – sequence: 3 givenname: Kathryn J. surname: Lindley fullname: Lindley, Kathryn J. organization: Department of Medicine (K.J.L.), Vanderbilt University Medical Center, Nashville, TN |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/37289905$$D View this record in MEDLINE/PubMed |
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CitedBy_id | crossref_primary_10_3390_jpm14010010 crossref_primary_10_1161_CIRCRESAHA_123_323095 crossref_primary_10_1038_s41598_024_66029_6 crossref_primary_10_1016_j_ahj_2024_06_002 crossref_primary_10_1080_13697137_2023_2287628 crossref_primary_10_1016_j_cjco_2023_09_020 crossref_primary_10_20960_angiologia_00619 crossref_primary_10_1161_CIRCRESAHA_123_322762 crossref_primary_10_1016_j_pcad_2024_01_001 crossref_primary_10_1186_s12933_024_02184_4 crossref_primary_10_1097_AOG_0000000000005569 crossref_primary_10_1152_ajpheart_00200_2023 |
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Snippet | Pregnancy is commonly referred to as a window into future CVH (cardiovascular health). During pregnancy, physiological adaptations occur to promote the optimal... Pregnancy is commonly referred to as a “window” into future cardiovascular health. During pregnancy, physiologic adaptations occur to promote the optimal... |
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SubjectTerms | Adult Cardiovascular Diseases - diagnosis Cardiovascular Diseases - epidemiology Female Humans Hypertension Infant, Newborn Peripartum Period Pregnancy Pregnancy Outcome Premature Birth - prevention & control |
Title | Pregnancy as an Early Cardiovascular Moment: Peripartum Cardiovascular Health |
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