Long-term risk of cardiovascular and cerebrovascular disease in women with a personal history of placental abruption
DOI:
https://doi.org/10.24265/horizmed.2022.v22n4.13Keywords:
Cardiovascular Diseases, Cerebrovascular Disorders, Pregnancy Complications, Fetal Membranes, Premature Rupture, Risk, Long-Term CareAbstract
Maternal and perinatal health is one of today’s global health priorities. Cardiovascular disease and stroke are the leading causes of maternal mortality. Placental abruption remains a critical concern for maternal morbidity because it has been associated with long-term vascular disease. However, there is neither much literature available in Spanish nor recent evidence elucidating some questions on this topic. Thus, this review aims to synthesize recent evidence on the long-term risk of cardiovascular and cerebrovascular disease in women with a personal history of placental abruption. It was found that, through complex pathophysiological mechanisms involving the structure and functionality of the placental vascular network with subsequent extension of vascular injury and production of proinflammatory and procoagulant factors which remain after delivery, major cardiovascular events are precipitated in the medium and long term. High-quality evidence has shown that the risk of maternal complications in women with placental abruption accounts for 2.14, rising even higher for those with severe placental abruption. In the medium and long term, the mortality risk caused by coronary heart diseases is 2.64 and by cerebrovascular disorders is 1.70, with equal risk for both ischemic and hemorrhagic strokes. It can therefore be concluded that cardiovascular and cerebrovascular risk is imminent in women with a history of placental abruption due to a number of vascular pathophysiological mechanisms. However, this risk is considerably increased when associated with traditional and non-traditional modifiable factors.
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Programa de Desarrollo de las Naciones Unidas. Objetivos de Desarrollo Sostenible [Internet]. PDNU; 2015. Disponible en: https://www.un.org/sustainabledevelopment/es/objetivos-de-desarrollo-sostenible/
U.S. Department of Health and Human Services. Global Health [Internet]. Disponible en: https://health.gov/healthypeople/objectives-and-data/browse-objectives/global-health
World Health Organization. Research in maternal, perinatal, and adolescent health [Internet]. WHO; 2018. Disponible en: https://www.who.int/activities/research-in-maternal-perinatal-and-adolescent-health
Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart disease and stroke statistics--2015 update: a report from the American Heart Association. Circulation. 2015; 131(4): e29-32.
Landon M, Galan H, Jauniaux E, et al. Gabbe's Obstetrics: Normal and problem pregnancies. 8th ed. New York: Elsevier; 2016.
Ananth CV. Ischemic placental disease: a unifying concept for preeclampsia, intrauterine growth restriction, and placental abruption. Semin Perinatol. 2014; 38(3): 131-2.
Elsasser DA, Ananth CV, Prasad V, Vintzileos AM. Diagnosis of placental abruption: relationship between clinical and histopathological findings. Eur J Obstet Gynecol Reprod Biol. 2010; 148(2): 125-30.
Ananth CV, Keyes KM, Hamilton A, Gissler M, Wu C, Liu S, et al. An international contrast of rates of placental abruption: an age-period-cohort analysis. PLoS One. 2015; 10(5): e0125246.
Tikkanen M. Placental abruption: Epidemiology, risk factors and consequences. Acta Obstet Gynecol Scand. 2011; 90: 140-9.
Ananth CV, Berkowitz GS, Savitz DA, Lapinski RH. Placental abruption and adverse perinatal outcomes. JAMA. 1999; 282(17): 1646-51.
Ananth CV, Patrick HS, Ananth S, Zhang Y, Kostis WJ, Schuster M. Maternal cardiovascular and cerebrovascular health after placental abruption: A systematic review and meta-analysis (CHAP-SR). Am J Epidemiol. 2021; 190(12): 2718-29.
Liñayo-Chouza J, Álvarez-Silvares E, Domínguez-Vigo P, Alves-Pérez MT, Castro-Vilar L. Morbilidad y mortalidad a largo plazo en mujeres con antecedente de desprendimiento prematuro de placenta normoinserta. Ginecol Obstet Méx. 2019; 87(3): 167-76.
Chen X, Li H, Lucero-Prisno DE, Abdullah AS, Huang J, Laurence C, et al. What is global health? Key concepts and clarification of misperceptions: Report of the 2019 GHRP editorial meeting. Glob Health Res Policy. 2020; 5: 14.
Moran PS, Wuytack F, Turner M, Normand C, Brown S, Begley C, et al. Economic burden of maternal morbidity - A systematic review of cost-of-illness studies. PLoS One. 2020; 15(1): e0227377.
Nuñez-Gomez JA, Medina-Bravo PA, Piñeros-López NF, Contreras GA, Rosero-Burgos ME, Lozada-Martínez ID, et al. Global outcomes, surgical teams and COVID-19 pandemic: Will the same objectives of global surgery persist? Ann Med Surg (Lond). 2021; 71: 103002.
Silva-Rued ML, Ramírez-Romero A, Guerra-Maestre LR, Forero-Hollmann ÁM, Lozada-Martínez ID. The need to develop specialized surgical centers: the evidence that surgical diseases cannot wait. Int J Surg. 2021; 92: 106036.
Schmidt P, Skelly CL, Raines DA. Placental Abruption [Internet]. En: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. Disponible en: https://www.ncbi.nlm.nih.gov/books/NBK482335/
Hall D. Abruption placentae and disseminated intravascular coagulopathy. Semin Perinatol. 2009; 33(3): 189-95.
Pitaphrom A, Sukcharoen N. Pregnancy outcomes in placental abruption. J Med Assoc Thai. 2006; 89(10): 1572-8.
Braila A, Gluhovschi A, Neacsu A, Virgil C, Braila M, Luminita E, et al. Placental abruption: etiopathogenic aspects, diagnostic and therapeutic implications. Rom J Morphol Embryol. 2018; 59(1): 187-95.
Oyelese Y, Ananth CV. Placental abruption. Obstet Gynecol. 2006; 108(4): 1005-16.
University of Calgary. The Calgary guide to understanding disease: Placental abruption [Internet]. 2022. Disponible en: https://calgaryguide.ucalgary.ca/placental-abruption/
Lane-Cordova AD, Khan SS, Grobman WA, Greenland P, Shah SJ. Long-term cardiovascular risks associated with adverse pregnancy outcomes: JACC Review Topic of the Week. J Am Coll Cardiol. 2019; 73(16): 2106-116.
Naruse K, Shigemi D, Hashiguchi M, Imamura M, Yasunaga H, Arai T, et al. Placental abruption in each hypertensive disorders of pregnancy phenotype: a retrospective cohort study using a national inpatient database in Japan. Hypertens Res. 2021; 44(2): 232-8.
Zhang J, Dunk C, Croy AB, Lye SJ. To serve and to protect: the role of decidual innate immune cells on human pregnancy. Cell Tissue Res. 2016; 363(1): 249-65.
Balasubbramanian D, Gelston CAL, Mitchell BM, Chatterjee P. Toll-like receptor activation, vascular endothelial function, and hypertensive disorders of pregnancy. Pharmacol Res. 2017; 121: 14-21.
McCarthy CG, Goulopoulou S, Wenceslau CF, Spitler K, Matsumoto T, Webb RC. Toll-like receptors and damage-associated molecular patterns: novel links between inflammation and hypertension. Am J Physiol Heart Circ Physiol. 2014; 306(2): H184-96.
Powe CE, Levine RJ, Karumanchi SA. Preeclampsia, a disease of the maternal endothelium: the role of antiangiogenic factors and implications for later cardiovascular disease. Circulation. 2011; 123(24): 2856-69.
Noori M, Donald AE, Angelakopoulou A, Hingorani AD, Williams DJ. Prospective study of placental angiogenic factors and maternal vascular function before and after preeclampsia and gestational hypertension. Circulation. 2010; 122(5): 478-87.
Kvehaugen AS, Dechend R, Ramstad HB, Troisi R, Fugelseth D, Staff AC. Endothelial function and circulating biomarkers are disturbed in women and children after preeclampsia. Hypertension. 2011; 58(1): 63-9.
Catov JM, Muldoon MF, Reis SE, Ness RB, Nguyen LN, Yamal JM, et al. Preterm birth with placental evidence of malperfusion is associated with cardiovascular risk factors after pregnancy: a prospective cohort study. BJOG. 2018; 125(8): 1009-17.
Kim YM, Chaemsaithong P, Romero R, Shaman M, Kim CJ, Kim JS, et al. The frequency of acute atherosis in normal pregnancy and preterm labor, preeclampsia, small-for-gestational age, fetal death and midtrimester spontaneous abortion. J Matern Fetal Neonatal Med. 2015; 28(17): 2001-9.
Hage C, Michaëlsson E, Linde C, Donal E, Daubert JC, Gan LM, et al. Inflammatory biomarkers predict heart failure severity and prognosis in patients with heart failure with preserved ejection fraction: A holistic proteomic approach. Circ Cardiovasc Genet. 2017; 10(1): e001633.
Cantonwine DE, Zhang Z, Rosenblatt K, Goudy KS, Doss RC, Ezrin AM, et al. Evaluation of proteomic biomarkers associated with circulating microparticles as an effective means to stratify the risk of spontaneous preterm birth. Am J Obstet Gynecol. 2016; 214(5): 631.e1-11.
Wölter M, Röwer C, Koy C, Rath W, Pecks U, Glocker MO. Proteoform profiling of peripheral blood serum proteins from pregnant women provides a molecular IUGR signature. J Proteomics. 2016; 149: 44-52.
Simmons LA, Gillin AG, Jeremy RW. Structural and functional changes in left ventricle during normotensive and preeclamptic pregnancy. Am J Physiol Heart Circ Physiol. 2002; 283(4): H1627-33.
Mahendru AA, Morris E. Cardiovascular disease in menopause: does the obstetric history have any bearing? Menopause Int. 2013; 19(3): 115-20.
Mehta PK, Minissian M, Bairey Merz CN. Adverse pregnancy outcomes and cardiovascular risk factor management. Semin Perinatol. 2015; 39(4): 268-75.
Adams T, Yeh C, Bennett‐Kunzier N, Kinzler WL. Long‐term maternal morbidity and mortality associated with ischemic placental disease. Semin Perinatol. 2014; 38(3): 146-50
Bellamy L, Casas JP, Hingorani AD, Williams DJ. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ. 2007; 335(7627): 974.
Brown MC, Best KE, Pearce MS, Waugh J, Robson SC, Bell R. Cardiovascular disease risk in women with pre‐eclampsia: systematic review and meta‐analysis. Eur J Epidemiol. 2013; 28(1): 1-19.
Catov JM, Wu CS, Olsen J, Sutton‐Tyrrell K, Li J, Nohr EA. Early or recurrent preterm birth and maternal cardiovascular disease risk. Ann Epidemiol. 2010; 20(8): 604-9.
LykkeJ A, Langhoff‐Roos J, Sibai BM, Funai EF, Triche EW, Paidas MJ. Hypertensive pregnancy disorders and subsequent cardiovascular morbidity and type 2 diabetes mellitus in the mother. Hypertension. 2009; 53(6): 944-51.
Larsson C, Matsson A, Mooe T, Soderstrom L, Tunón K, Nordin P, et al. Cardiovascular complications following cesarean section and vaginal delivery: a national population-based study. J Matern Fetal Neonatal Med. 2021; 1-8.
Marik PE, Plante LA. Venous thromboembolic disease and pregnancy. N Engl J Med. 2008; 359: 2025-33.
Konkle BA. Diagnosis and management of thrombosis in pregnancy. Birth Defects Res C Embryo Today. 2015; 105: 185-9.
Cantú C, Barinagarrementeria F. Cerebral venous thrombosis associated with pregnancy and puerperium. Review of 67 cases. Stroke. 1993; 24: 1880-4.
James AH. Thrombosis in pregnancy and maternal outcomes. Birth Defects Res C Embryo Today. 2015; 105: 159-66.
Kittner SJ, Stern BJ, Feeser BR, Hebel R, Nagey DA, Buchholz DW, et al. Pregnancy and the risk of stroke. N Engl J Med. 1996; 335: 768-74.
Dias MS, Sekhar LN. Intracranial hemorrhage from aneurysms and arteriovenous malformations during pregnancy and the puerperium. J Neurosurg. 1990; 27: 855-65.
Horton JC, Chambers WA, Lyons SL, Adams RD, Kjellberg RN. Pregnancy and the risk of hemorrhage from cerebral arteriovenous malformations. J Neurosurg. 1990; 27: 867-71
Fugate JE, Ameriso SF, Ortiz G, Schottlaender LV, Wijdicks EF, Flemming KD, et al. Variable presentations of postpartum angiopathy. Stroke. 2012; 43: 670-6.
Feske SK. Stroke in pregnancy. Semin Neurol. 2007; 27: 442-52.
Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol. 2009; 8(4): 355-69.
Miller EC, Gatollari HJ, Too G, Boehme AK, Leffert L, Elkind MS, et al. Risk of pregnancy- associated stroke across age groups in New York State. JAMA Neurol. 2016; 73(12): 1461-7.
Veerbeek J, Smit J, Koster M, Post E, Rijn B, Koenen S, et al. Maternal cardiovascular risk profile after placental abruption. Hypertension. 2013; 61(6): 1297-301.
Ananth CV, Hansen AV, Elkind MSV, Williams MA, Rich-Edwards JW, Nybo Andersen AM. Cerebrovascular disease after placental abruption. A population-based prospective cohort study. Neurology. 2019; 93(12): 1148-58.
Jenabi E, Salimi Z, Ayubi E, Bahirian S, Salehi A. The environmental risk factors prior to onception associated with placental abruption: an umbrella review. Systematic Reviews. 2022; 11(1): 55.
Bellamy L, Casas JP, Hingorani AD, Williams DJ. Pre-eclampsia and risk of cardiovascular disease and cancer later in life: systematic review and meta-analysis. BMJ. 2007; 335(7629): 974.
Hauspurg A, Ying W, Hubel CA, Michos ED, Ouyang P. Adverse pregnancy outcomes and future maternal cardiovascular disease. Clin Cardiol. 2018; 41(2): 239-46.
Khazaei S, Jenabi E, Veisani Y. The association of Mullerian anomalies and placenta abruption: a meta-analysis. J Matern Fetal Neonatal Med. 2019; 32(3): 512-6.
Jenabi E, Zagami S. The association between uterine leiomyoma and placenta abruption: a meta-analysis. J Matern Fetal Neonatal Med. 2017; 30(22): 3742-6.
Kes A, Ogwang S, Prabha R, Douglas Z, Karuga R, Odhiambo F, et al. The economic burden of maternal mortality on households: evidence from three sub-counties in rural western Kenya. Reproductive Health. 2015; 12(Suppl. 3).
Graves M, Howse K, Pudwell J, Smith G. Pregnancy-related cardiovascular risk indicators: primary care approach to postpartum management and prevention of future disease. Can Fam Physician.2019; 65(12): 883-9
Deneux C. Pregnancy complications and women’s long-term health: challenges for research and care. Paediatr Perinat Epidemiol. 2017; 31(3): 219-20.
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