Education And Debate

Pregnancy complications and maternal cardiovascular risk: opportunities for intervention and screening?

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7356.157 (Published 20 July 2002) Cite this as: BMJ 2002;325:157
  1. Naveed Sattar, reader in endocrinology and metabolism (nsattar@clinmed.gla.ac.uk),
  2. Ian A Greer, professor of obstetrics and gynaecology.
  1. Glasgow Royal Infirmary University NHS Trust, Glasgow G31 2ER
  1. Correspondence to: N Sattar
  • Accepted 8 November 2001

The link between defective nutrition of the fetus and vascular disease in later life is now well established. Naveed Sattar and Ian Greer report on the intriguing probability that complications in pregnancy also predispose mothers to later vascular and metabolic disease

Plentiful evidence now links low birth weight due to intrauterine growth restriction and increased risk of vascular disease in later adult life. This is considered to be partly the result of programming through fetal nutrition.1 In contrast, much less attention has been focused on the relation between adverse pregnancy outcomes, such as pre-eclampsia, gestational diabetes, preterm delivery, and intrauterine growth restriction, and the mother's subsequent health, and interesting data are now increasingly linking the maternal vascular, metabolic, and inflammatory complications of pregnancy with an increased risk of vascular disease in later life (table). This article summarises the emerging evidence to support this fascinating concept, notes important areas for further research, and discusses potential practical implications.

Summary points

Women with a history of adverse pregnancy outcome appear to be at increased risk of metabolic and vascular diseases in later life

Pregnancy complications and coronary heart disease may have common disease mechanisms

Women with a history of gestational diabetes should be screened for type 2 diabetes and be given counselling and appropriate lifestyle advice

Women who have had a very low birthweight baby or combined complications seem to be at severalfold increased risk of mortality from cardiovascular causes and should be screened for vascular risk factors in their late 30s.

The possibility that maternal vascular risk factors, potentially ‘modifiable’ before pregnancy, correlate with increased risk of preterm delivery and low birth weight, and thus fetal programming, requires further investigation

View this table:

Association of adverse pregnancy outcomes with risk of diabetes or risk factors for coronary heart disease and vascular disease

Metabolic syndrome

A key factor underlying …

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