Maternal outcomes:
Women with a history of HDP are at increased risk of developing premature cardiovascular diseases such as hypertension, stroke and ischaemic heart disease later in life1,2. It is unclear whether pregnancy unmasks their cardiovascular risk, or whether HDP are an index event causing cardiovascular damage given the oft shared cardiovascular risk factors. The underlying pathophysiological mechanism for this association is unknown, though plausibly might relate to endothelial dysfunction and subclinical inflammation or ischaemia that persists for years in both the large vessels and microvasculature after delivery 2,3. Exploration of these potential mechanisms will be discussed briefly.
Offspring outcomes:
The associations between HDP and subsequent cardiovascular disease in the offspring are complex. Recent observational epidemiological studies have demonstrated that maternal hypertensive disorders are associated with an adverse cardio-metabolic risk in adult offspring (including raised body mass index, overweight and obesity and higher blood pressure)4,5. Both pre-eclampsia and gestational hypertension are associated with hypertension and stroke in the adult offspring5.
Postpartum follow up:
There is substantial variation in clinical recommendations and guidelines as to the optimal management of these women postpartum6. There is ongoing need for further research to determine effective and cost-efficient follow-up strategies of these high-risk women. The postpartum period offers an ideal opportunity to improve education, offer lifestyle intervention, make an early diagnosis of chronic hypertension and provide appropriate treatments to prevent and potentially reduce long term cardiovascular risk.