Pregnancy complications may be warning signs for later chronic disease

Report recommends women alert their doctors about conditions during earlier pregnancies.

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By Linda Carroll

Pregnancy stresses a woman's body. In some cases, it can unmask health problems and, in others, it might actually contribute to the development of future disease, experts say.

Certain types of pregnancy complications should be viewed as warning signs that a woman is at increased risk of developing chronic conditions like diabetes and hypertension in the years after her child is born, a new set of recommendations published Thursday in Obstetrics & Gynecology and the American Journal of Obstetrics and Gynecology suggest.

That means that women who experience certain pregnancy complications need to be aware of a heightened risk of future health problems. As a result, experts are now recommending yearly visits to both a gynecologist and a primary care physician for women who have experienced these complications so that early signs of chronic diseases can be screened for and detected.

“This concept of pregnancy as a window to the future is a sort of general notion that the events that occur during pregnancy either reveal a predisposition or can contribute directly to chronic conditions,” said Dr. Hy Simhan, a leader of the department of obstetrics and gynecology at Magee-Womens Hospital at the University of Pittsburgh Medical Center. “So, while a condition like gestational diabetes or preeclampsia may resolve with the delivery of the baby, there is still an underlying physiology that can persist and create complications later in life.”

Pregnancy is able to provide this insight because it stresses the body. In some cases, that stress unmasks health problems that had not been seen before, and in others it might actually contribute to the development of those conditions.

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The report, released Thursday by the American College of Obstetricians and Gynecologists, found these conditions during pregnancy could also signal future health issues.

Gestational diabetes

While the condition generally resolves with delivery of the baby, that doesn’t mean all is right with the mom. Women with gestational diabetes have seven times the risk of developing Type 2 diabetes compared with women whose blood sugar stays low during pregnancy. And that means “she needs to be screened for Type 2 diabetes at her postpartum visit, six to eight weeks after the baby is born, and annually thereafter,” said Simhan.

Preeclampsia

This condition, which involves both hypertension and protein spilling into the urine, can unmask a woman’s tendency to develop chronic hypertension and possible heart disease later in life. She’s also at risk of a recurrence of preeclampsia during future pregnancies.

“So if a woman has had preeclampsia you always want to check her blood pressure, and sometimes we send a letter to her primary care provider saying that she had severe hypertension during pregnancy — that way it becomes part of her permanent medical record,” said Dr. Patrice Harold, director of minimally invasive gynecology at Detroit Medical Center’s Hutzel Women’s Hospital. “It’s probably a sign that some of the smaller blood vessels are very, very narrow either because of the pregnancy or because of the woman’s underlying health status. You want to monitor her because it could progress to damage the eyes, the kidneys or the heart.”

Preventative therapy is usually a blood thinner, Harold said.

Gestational hypertension

Gestational hypertension: As with gestational diabetes, high blood pressure during pregnancy generally resolves with the birth of the child. But that doesn’t mean the mom is completely healthy. Women who have had high blood pressure during pregnancy have an increased risk of developing chronic hypertension and twice the risk of others for developing heart disease, according to the report.

Smaller-than-normal baby

“There’s a concern that the blood flow to the placenta was not sufficient or the body didn’t create a very robust placenta,” said Dr. Leena Nathan, an assistant OB-GYN professor at the University of California, Los Angeles. “And this can be an indication of vascular disease throughout the body.”

Mood symptoms

“In pregnancy, the hormonal effects can cause a lot of mood issues in women who may not have had a lot of issues with anxiety or depression before,” Nathan said. “Pregnancy can unmask underlying mood issues that persist after the pregnancy period.”

Still births

“Women who have a stillbirth are at risk for autoimmune conditions, such as antiphospholipid antibody syndrome,” Simhan said. “It’s a rare pregnancy condition and a rare outcome.” Stillbirths can also unmask undiagnosed lupus, Harold said.