Pregnancy complications and maternal cardiovascular risk: opportunities for intervention and screening?

Abstract

Metabolic syndrome A key factor underlying cardiovascular disease and, in particular, coronary heart disease, is the metabolic syndrome. The metabolic syndrome is a spectrum of metabolic abnormalities associated with insulin resistance, which is manifest as relative hyperglycaemia, hyperlipidaemia, and disturbance of coagulation. The normal physiological response to pregnancy represents a transient excursion into a metabolic syndrome in which several components are acquired: a relative degree of insulin resistance, definite hyperlipidaemia, and an increase in coagulation factors. 12 13 Normal pregnancy also involves upregulation of the inflammatory cascade and an increase in white cell count.14 Such upregulation in non-pregnant women has recently been recognised as an additional risk factor for cardiovascular disease, as markers of inflammation such as C-reactive protein, interleukin-6, and raised white cell count have been found to be independent predictors of cardiovascular events and diabetes.15 All these metabolic changes of pregnancy are likely to be the result of hormonal changes, either direct or indirect, through regulation of early fat acquisition and its rapid mobilisation in the second half of pregnancy.16 Such metabolic responses could be considered as “stress” tests of maternal carbohydrate and lipid pathways and vascular function. In this way, adverse pregnancy outcome may be an indicator of increased risk of metabolic and vascular diseases in later life (figure). View larger version: In this window In a new window Risk factors for vascular disease are identifiable during excursions into the metabolic syndrome of pregnancy