American Journal of Medicine, internal medicine, medicine, health, healthy lifestyles, cancer, heart disease, drugs

Significance of Obstetrical History with Future Cardiovascular Disease Risk

obstetrician visit

The maternal cardiovascular system undergoes profound changes to support the increasing demands of fetal growth during pregnancy.1 It is well established that pregnancy complications have lifelong implications on the health of the offspring. However, the effect these complications have on the long-term health of mothers is less understood.2 An accumulating body of evidence has shown that common pregnancy complications, including gestational diabetes mellitus, preeclampsia, low birth weight, and preterm delivery,2 can be associated with future cardiovascular adverse events in mothers. This review highlights the implications of cardiovascular disease, one of the leading causes of female mortality, in pregnancy.3

Gestational Diabetes Mellitus

According to the World Health Organization, cardiovascular disease is the most common cause of death globally, approximating 30%, while gestational diabetes mellitus in the developed world has increased at an alarming rate over the last few years as well. Gestational diabetes mellitus is any degree of glucose intolerance with onset during pregnancy.4 In pregnancy there is progressively increasing insulin resistance in the second and third trimester, with the diagnosis generally appearing when glucose intolerance continues beyond 24-28 weeks of gestation. Links found in patients with a history of gestational diabetes mellitus with an increased risk of cardiovascular disease are attributed to the development and onset of Type 2 diabetes mellitus.5 Additional studies have also demonstrated that women with a history of gestational diabetes mellitus develop subclinical atherosclerosis,6 an increased risk of cardiac dysfunction,7, 8 increased markers of endothelial dysfunction,9 and a significantly higher prevalence of metabolic syndrome soon after pregnancy.10 In a large database analysis of deliveries (2007-2008),5 gestational diabetes mellitus was associated with a significantly higher risk of cardiovascular disease, which included angina pectoris, myocardial infarction, and hypertension over a follow-up period of 7 years postpartum.

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-Emmanuel Bassily, MDa,, Cameron Bell, MDa, Sean Verma, MDa, Nidhi Patel, MDb, Aarti Patel, MDb

This article originally appeared in the May 2019 issue of The American Journal of Medicine.

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