Many physiological changes occur in pregnancy, beginning early in gestation. These changes can interact with an inherited predisposition for cardiovascular disorders that is unmasked by pregnancyinduced metabolic changes. The most important metabolic changes during pregnancy are an increase in plasma volume of 50% in the third trimester with an activation of the renin-angiotensin system, an increase in insulin resistance and changes in the haemostatic and procoagulant systems.
1 Hypertensive disorders complicate 10% of all pregnancies and cover a spectrum of conditions such as gestational hypertension, chronic hypertension and preeclampsia. In a large retrospective cohort study in more than one million women in Canada it was shown that the risk of premature cardiovascular disease (CVD) is strongly related to the severity of metabolic disturbances that have occurred during pregnancy.
2 Women with a placental syndrome in combination with poor foetal growth or intrauterine death were found to be at greatest risk. The future risk of (premature) CVD was also higher in women with the traditional cardiac risk factors and the metabolic syndrome. In a matched cohort study, with a follow-up duration of 30 to 50 years, it was found that women with gestational hypertension or preeclampsia had a significantly higher risk for the development of hypertension later in life and the occurrence of hypertensive-related diseases.
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