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Pregnancy as the prodrome to vascular dysfunction and cardiovascular risk

Nature Clinical Practice Cardiovascular Medicine volume 3, pages 596–603 (2006)Cite this article

Abstract

In previously apparently healthy women, glucose intolerance and high blood pressure during pregnancy are common and frequently occur together. This article reviews the role of these gestational disorders as markers of vascular dysfunction and its pathophysiology. Mechanisms include alterations to function of large arteries and resistance vessels and to capillary blood flow. Much of the vessel pathology is seen in both gestational diabetes and hypertension. In women who have had transient diabetes during pregnancy and later redeveloped overt diabetes, cardiovascular risk is already elevated nearly fourfold before diagnosis, which is almost as high as the average risk after a clinical diagnosis of diabetes is made. This key finding suggests that vascular risk in such women is at least partly independent of overt hyperglycemia.

Key Points

  • Gestational diabetes and gestational hypertensive disorders might have common underlying pathophysiological mechanisms

  • Gestational diabetes and gestational hypertensive disorders are associated with vascular dysfunction demonstrable in small and large vessels

  • Long-term follow-up studies seem not to have been done in women with gestational diabetes, although studies in women with gestational hypertensive disorders have demonstrated raised cardiovascular risk

  • Early intervention in women with gestational diabetes or hypertension, as well as better definition of their risk, could help to prevent future cardiovascular disease

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Acknowledgements

We thank Ms J Stewart and Miss K Molloy for help in preparation of the manuscript.

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Authors and Affiliations

  1. British Heart Foundation Fellow and JK Cruickshank is Professor of Cardiovascular Medicine and Clinical Epidemiology at Manchester Royal Infirmary, UK

    M Banerjee & JK Cruickshank

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  1. M Banerjee
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Correspondence to M Banerjee.

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Banerjee, M., Cruickshank, J. Pregnancy as the prodrome to vascular dysfunction and cardiovascular risk. Nat Rev Cardiol 3, 596–603 (2006). https://doi.org/10.1038/ncpcardio0683

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