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Pregnancy complications and later cardiovascular risk.

26 April 2021

During a woman's reproductive and post reproductive years, certain events can influence later health such as cardiovascular health, and can serve as opportunities to raise awareness of risk and so allow intervention.
The menopause is a time of great change not only in relation to symptoms that women may experience and what impact symptoms may have on their lives, but also in terms of change in cardiovascular and bone health, especially if menopause occurs early.

It has been known for some time that certain pregnancy complications, such as preeclampsia, other hypertensive disorders of pregnancy, and gestational diabetes are associated with high blood pressure and increased cardiovascular risk in the mother in later years, which can then be worsened further at the menopause.
A recently published study examined whether blood pressure changes during the menopausal transition were affected by having had a preterm or small for gestational age (SGA) birth compared to women with full-term or appropriate-for-gestational-age births (AGA).

The Study of Women's Health Across the Nation (SWAN) looked at 1008 women who had blood pressure measurements before the last period at around the age of 46, at the time of the menopause, and then up to 10 years after the last period.
101 (10%) reported a prior preterm birth, and 102 (10.1%) reported a term SGA birth. Compared to women with all term AGA births, women with a term SGA birth had higher BP before the final menstrual period, at the final menstrual period, and up to 10 years after the final menstrual period; women with a preterm birth had higher BP in the postmenopausal years. Annual rate of change in BP during the menopause transition did not differ between pregnancy groups.
The authors concluded that women with a history of preterm and term SGA delivery have higher BP than women with all term AGA births during the menopause transition, but rate of change in BP does not differ in these groups relative to final menstrual period.
It appears that these pregnancy-related conditions, not just preeclampsia or other hypertensive disorders of pregnancy, are associated with a cardiovascular risk factor, and it suggests that, particularly for women who had an SGA birth, checking blood pressure frequently and also during the premenopausal years would be indicated. This could help to identify and treat hypertension and reduce future cardiovascular risk.

Women and healthcare professionals should be aware of the pregnancy-related complications which are associated with future cardiovascular health risk and use the opportunity to plan assessments during later years including during the menopause transition, so that interventions can be employed to reduce risk.

Reference: Impact of prior preterm or term small for gestational age birth on maternal blood pressure during the menopause transition in the Study of Women's Health Across the Nation. Yamnia I Cortés , Maria Brooks , Emma Barinas-Mitchell , et al.
Menopause. 2021 Feb 8;28(3):255-262.

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