Preeclampsia: No longer solely a pregnancy disease

Abstract

Preeclampsia, the leading cause of maternal and perinatal morbidity and mortality, has been recently considered not only a pregnancy disease but also a risk factor for developing diseases later in life. Preeclampsia is becoming a disease of interest to internists and not just obstetricians. Women who have had preeclampsia seem to be at higher risk of premature death, mortality from ischemic heart disease, cardiovascular diseases including ischemic heart disease and hypertension, fatal and non-fatal stroke, venous thromboembolism, renal failure, type 2 diabetes mellitus, hypothyroidism, and cognitive defects, although they appear surprisingly protected from cancer. Furthermore, having had preeclampsia is a problem not only for the mother’s future health, but it also affects the offspring’s adult health.

Children born from preeclamptic pregnancies are more prone to hypertension, insulin resistance and diabetes mellitus, neurological problems, stroke, and mental disorders along their life.

Whether preeclampsia is a risk factor for disease later in life or it creates long-term organ damage is an intriguing question.

This review analyzes recent epidemiological evidence of the long-term outcomes of preeclampsia and the background mechanisms of this phenomenon. Understanding the etiological background may provide guidance for the prevention and follow-up of women who experience preeclampsia.

Introduction

Preeclampsia is a leading direct cause of maternal and fetal morbidity and mortality worldwide, and it has a reported incidence of 2–8% among pregnancies.

Preeclampsia is a hypertensive disorder of pregnancy, and it is associated with substantial maternal and perinatal complications; these complications are both acute and long-term, surpassing the index pregnancy.

Acute maternal complications from preeclampsia include eclampsia, ischemic or hemorrhagic stroke, abruptio placentae, hemolysis, liver damage, and thrombocytopenia (HELLP syndrome with or without hemorrhage), disseminated intravascular coagulation, liver hemorrhage/rupture, pulmonary edema, adult respiratory distress syndrome, acute renal failure and death [1]. Despite all these severe systemic complications, hypertensive disorders of pregnancy were historically believed to be self-limiting, with minimal residual effects on health once the pregnancy had ended, and the placenta alone was considered to be mainly responsible for the disease.

Since recently, preeclampsia is no longer considered to be only a disease of pregnancy, but rather a disease with lifelong implications for the mother and infant: according to several epidemiologic case–control, and prospective studies, preeclampsia is associated with an increased maternal risk of developing a variety of pathological conditions, including chronic hypertension [2], [3], [4], [5], ischemic heart disease [6], [7] neurologic deficits and cerebrovascular disease, thromboembolism, type-2 diabetes mellitus [3], [8], [9] chronic renal failure [4], [10], [11], [12] and premature death [13], [14].

Despite these conflicting results, women who have had preeclampsia also seem surprisingly protected from cancer [15], [16].

A history of preeclampsia might, therefore, predict or predispose women to a range of chronic diseases years after an affected pregnancy. The debate of whether preeclampsia shares common predisposing risk factors with later diseases or whether it creates long-term organ damage is still an open research question.

Moreover, children born of preeclamptic pregnancies have long-term complications and increased disease vulnerability later in life [17].

In this review, we will analyze recent epidemiological evidence of long-term outcomes of preeclampsia and the pathological mechanisms behind this phenomenon.