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- May 11, 2008 |
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"Dysmetabolic Syndrome, Adverse Pregnancy Outcome and the Future Risk of Cardiovascular Disease"Dr. Joel Ray (biography)
English - 2005-01-21 - 32 minutes
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Summary :
The Dysmetabolic Syndrome also known as Metabolic Syndrome, is known to increase the risk of premature cardiovascular disease. In this presentation Dr. Ray presents evidence showing features of the dysmetabolic syndrome to be associated with adverse pregnancy outcomes such as preeclampsia, poor fetal growth, intrauterine fetal death and preterm birth, and how these conditions in turn affect the risk of future cardiovascular morbidity and mortality.
With regards to the effects of obesity, the Nurses Health Study II found a relationship between pre-pregnancy body mass index (BMI) and the risk of gestational diabetes (1), and a systematic overview of 13 cohort studies found that higher pre-pregnancy BMI increased the risk of preeclampsia (2). Cnattingius et al. also reported an increased risk of late fetal death with increasing pre-pregnancy obesity (3). Adequate physical activity before 20 weeks of pregnancy has been associated with a lower risk of developing preeclampsia (4).
In a small study by Wolf et al. utilising the HOMA-IR method, higher levels of insulin resistance were found in preeclamptic women at 18 months postpartum compared to normotensive women (5). A number of observational studies have also demonstrated a higher prevalence of hypertriglyceridemia in women with preeclampsia (6).
The presence of chronic hypertension is also associated with adverse perinatal outcomes: small for gestational age birthweight infants and perinatal death (7).
With regards to cardiovascular risk, a data-linkage cohort study from Scotland showed that the risk of hospitalization or death due to ischemic heart disease was greatest in women having a small for gestational age birthweight infant plus a preterm delivery plus preeclampsia (8,9). The Norwegians have done similar data linkage analyses. An increased risk of future all-cause and cardiovascular mortality was associated with preeclampsia and preterm delivery (10). A population-based study reported by Kestenbaum also showed that gestational hypertension and preeclampsia were associated with an increased risk of hospitalization for cardiovascular disease (11).
Gestational hypertension and preeclampsia have been linked specifically to increased risk of stroke (12), and the risk of future development of stroke was found to be increased in women having had a preterm delivery and/or low birthweight infant (8,9).
Finally, a recently published Finnish case control study showed preeclampsia as a risk factor for coronary artery disease (13).
Dr. Ray ends his talk with some comments on the need for physical activity and dietary control in pregnant women.
Copyright © 2005 E-MedHosting.com Inc.
Learning objectives :
After viewing this presentation the participant will be able to discuss studies showing:
- Adverse (placenta-mediated) outcomes in pregnancy that are associated with features of the dysmetabolic syndrome
- The effect of these adverse outcomes on the risk of future cardiovascular morbidity and mortality
Bibliographic references :
1. C. G. Solomon, W. C. Willett, V. J. Carey, J. Rich-Edwards, D. J. Hunter, G. A. Colditz, M. J. Stampfer, F. E. Speizer, D. Spiegelman and J. E. Manson. A prospective study of pregravid determinants of gestational diabetes mellitusJAMA.1997;278(13):1078.
2. O'Brien TE, Ray JG, Chan WS.
Maternal body mass index and the risk of preeclampsia: a systematic overview.Epidemiology. 2003 May;14(3):368-74.
3. Sven Cnattingius, M.D., Ph.D., Reinhold Bergström, Ph.D., Loren Lipworth, Sc.D., and Michael S. Kramer, M.D.
Prepregnancy Weight and the Risk of Adverse Pregnancy Outcomes NEJM.1998;338:147-152.
4. Tanya K. Sorensen; Michelle A. Williams; I-Min Lee; Edward E. Dashow; Mary Lou Thompson; David A. Luthy Recreational Physical Activity During Pregnancy and Risk of Preeclampsia Hypertension. 2003;41:1273.
5. Myles Wolf, Carl A. Hubel, Chun Lam, Marybeth Sampson, Jeffrey L. Ecker, Roberta B. Ness, Augustine Rajakumar, Ashi Daftary, Alia S. M. Shakir, Ellen W. Seely, James M. Roberts, Vikas P. Sukhatme, S. Ananth Karumanchi and Ravi Thadhani. Preeclampsia and Future Cardiovascular Disease: Potential Role of Altered Angiogenesis and Insulin Resistance JCEM.2004;89(12):6239.
6. Clausen T, Djurovic S, Henriksen T.Dyslipidemia in early second trimester is mainly a feature of women with early onset pre-eclampsia.
BJOG. 2001 Oct;108(10):1081-7.
7. J.G. Ray, R.F. Burrows, E. A. Burrows and M. J. VermeulenMOS HIP: McMaster outcome study of hypertension in pregnancy Early Human Development. Volume 64, Issue 2 , September 2001, Pages 129-143.
8. Gordon CS Smith MD, Jill P Pell MD and David Walsh MScPregnancy complications and maternal risk of ischaemic heart disease: a retrospective cohort study of 129 290 births The Lancet.
Volume 357, Issue 9273 , 23 June 2001, Pages 2002-2006.
9. Jill P. Pell, Gordon C. S. Smith and David Walsh. Pregnancy Complications and Subsequent Maternal Cerebrovascular Events: A Retrospective Cohort Study of 119,668 Births Am J Epidemiol 2004; 159:336-342.
10. Henrik U Irgens, Lars Reisæter, Lorentz M Irgens and Rolv T LieLong term mortality of mothers and fathers after pre-eclampsia: population based cohort studyBMJ 2001;323:1213-1217.
11. Kestenbaum B, Seliger SL, Easterling TR, Gillen DL, Critchlow CW, Stehman-Breen CO, Schwartz SM. Cardiovascular and thromboembolic events following hypertensive pregnancy.Am J Kidney Dis. 2003 Nov;42(5):982-9.
12. Brenda J Wilson, M Stuart Watson,Gordon J Prescott, Sarah Sunderland, Doris M Campbell,Philip Hannaford and W Cairns S SmithHypertensive diseases of pregnancy and risk of hypertension and stroke in later life: results from cohort study BMJ 2003;326:845.
13. Leena Haukkamaa MD, Minna Salminen MD, Hannele Laivuori PhD, Hannu Leinonen PhD, Vilho Hiilesmaa PhD and Risto Kaaja PhD. Risk for subsequent coronary artery disease after preeclampsiaThe American Journal of Cardiology. Volume 93, Issue 6 , 15 March 2004, Pages 805-808 .
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