Back in the days when pre-eclampsia was defined as hypertension, proteinuria and oedema, it was thought that this disorder of pregnancy was a relatively short lived illness and that the woman eventually made a complete recovery after the pregnancy.
There is now evidence to show that the development of pre-eclampsia during pregnancy has long term consequences for the health of the mother and her offspring. Pre-eclampsia increases a woman’s risk of developing long term hypertension nearly 4 fold, while her risk of developing cardiovascular disease later in life doubles. Risks of developing ischaemic heart disease, stroke and thrombo-embolic disease are also nearly doubled. The risk of end stage renal disease is increased 4 fold. There are also increased risks of type II diabetes and thyroid dysfunction. Cognitive impairment can also be detected months after pre-eclampsia. The risks of these long term outcomes appear to be further increased in women with early onset pre-eclampsia.
The development of cardiovascular disease after pre-eclampsia is not really surprising given that these disorders share many clinical risk factors and also have common pathophysiological mechanisms. Whether the pre-eclampsia itself causes additional metabolic and vascular damage further contributing to long term cardiovascular risk remains to be determined. A woman who develops a hypertensive disorder in pregnancy should therefore be followed up in the future to reduce her cardiovascular risk.
The offspring of pregnancies affected by pre-eclampsia have higher blood pressures and BMI in childhood, which may put them on a trajectory for cardiovascular disease later in life.
Just as good general medical health of the mother is essential for a successful pregnancy, a good uterine environment is essential for the long term general medical health of the child.