What does preeclampsia have to do with a heart cath?

During pregnancy, most women’s doctors will tell them about the warning signs and symptoms of common pregnancy complications like headache and vision changes for preeclampsia, or abdominal pain and bleeding for placental abruption. Preeclampsia is a syndrome of high blood pressure with multiple organ system involvement in the second half of pregnancy, and placental abruption is the premature separation of the placenta from the uterine wall, causing bleeding. These pregnancy complications have very different symptoms, treatments, and outcomes. However, they have one thing in common: they stem from a problem with the placenta. Researchers have grouped together a set of pregnancy complications that are all believed to start with insufficiencies in the placenta, called “maternal placental syndromes.” Maternal placental syndromes include gestational hypertension (high blood pressure in pregnancy), preeclampsia, placental abruption, and placental infarction (blood clot in the placenta).

Maternal placental syndromes can have effects later in the mother’s life, including an increased risk of premature coronary artery disease. Coronary artery disease is when plaque builds up inside the heart’s arteries. “Premature” disease indicates coronary artery disease that occurs at a younger age than it typically does. 

The January 2016 Gray Journal features an article (here) by Dr. Ray and colleagues from the University of Toronto studying women with premature coronary artery disease. They conducted a retrospective review of the records of all women seen in hospitals in Ontario for two heart procedures- percutaneous coronary intervention (aka a heart cath) or a coronary artery bypass graft (aka heart bypass surgery) between 1993 and 2012. These two interventions are known collectively as “coronary artery revascularization.” The mean age was 45.

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The study authors hypothesized that they would find a link between maternal placental syndromes and survival after these two coronary heart disease interventions. Of the 1,985 women who underwent coronary artery revascularization, 18% had a history of previous maternal placental syndrome in the past. About 5 years after the coronary interventions, the rate of death was 2.2 per 100 person-years for women with a history of maternal placental syndrome and 1.1 per 100 person-years for women without such a history. Therefore, a history of maternal placental syndrome was associated with a 2X risk of death. For women with maternal placental syndrome in two or more pregnancies, the risk of death was over 4X. The authors took into account age, socioeconomic status, number of deliveries, revascularization type, time since last delivery, hypertension, diabetes, obesity, lipid disorders, tobacco, drugs, and kidney disease.

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These findings suggest that there is a need for increased vigilance and preventative interventions for women with a history of maternal placental syndromes, well past the immediate postpartum period, into middle age and beyond.