Placental and maternal cardiovascular health: a life course approach

The general aim of this thesis was to study maternal health in relation to placenta-related pregnancy complications, such as preeclampsia and foetal growth restriction, and to study methods to monitor adaptation to pregnancy. We report unfavourable lipid profiles and glucose homeostasis in women with a history of a foetal growth restricted pregnancy, independent of whether hypertension was also present. The enormous impact of a preeclampsia diagnosis is reported by evaluation of patient experiences. A prediction model for recurrent preeclampsia was developed, unfortunately with poor performance after internal validation. We describe the different methods for monitoring of cardiac output during pregnancy with the aim of standardizing the assessment of cardiac output. Also, the physiological response to a submaximal cardiopulmonary exercise test during early pregnancy is reported. We present a research protocol to study hemodynamic adaptation to pregnancy, with the first measurements prior to pregnancy. The first results of this study show that women with subsequent viable pregnancies have more favourable cardiometabolic profiles compared to women who did not conceive or who experienced a miscarriage.
In conclusion, pregnancy complications are recognized as markers of impaired future maternal cardiovascular health. Women with pregnancy complications need to be included in follow-up programs to improve early indicators of impaired cardiovascular health in order to lower their lifetime risk for cardiovascular disease. It seems essential that a life course approach to women’s health is constructed, to facilitate early recognition and improvement of risk factors in order to achieve better reproductive outcomes and maternal cardiovascular health.