Study highlights the need for enhanced cardiovascular care during pregnancy
A new study has uncovered critical insights into the connection between hypertensive disorders of pregnancy (HDP) and life-threatening cardiovascular complications during delivery. Published in聽JAMA Network Open, the research highlights how the severity and type of HDP鈥攕uch as chronic hypertension, preeclampsia, and HELLP syndrome鈥攕ignificantly impact health risks for pregnant individuals.
The study, led by聽, Scientist in the聽聽at the Research Institute of the 9I制作厂免费 Health Centre (The Institute), was conducted together with聽, the Co-director of the CHAL Program at The Institute, Dr. Kara Nerenberg and Dr. Amy Metcalfe from University of Calgary, and Dr. Kelsey McLaughlin and Dr. Sonia Grandi from University of Toronto.
With maternal morbidity rising across North America, cardiovascular complications such as pulmonary edema and stroke are among the leading causes of pregnancy-related mortality. The findings from Dr. Malham茅 and her team emphasize the importance of personalized care for individuals with HDP to mitigate severe health risks during delivery and in the postpartum period.
鈥淚t is important to understand the association between hypertensive disorders and serious maternal complications occurring during or shortly after pregnancy,鈥� says Dr. Malham茅. 鈥淲e sought to better understand how the type and severity of HDP influence the risk of cardiovascular complications, paving the way for improved care strategies tailored to each patient鈥檚 needs.鈥�
Key findings: HDP severity and cardiovascular risks
The study demonstrated that the type and severity of HDP鈥攔anging from chronic hypertension and preeclampsia to HELLP syndrome鈥� significantly influenced the risk of cardiovascular complications. Drawing on data from a population-based cohort study of more than 15 million deliveries, the research revealed that HELLP syndrome, the most severe form of HDP, showed the strongest association with cardiovascular complications at delivery.
鈥淥ur group is particularly focused on developing methods to prevent acute cardiovascular complications related to HDP,鈥� explains Dr. Malham茅. 鈥淭his research highlights the critical need for better risk stratification to prevent potentially life-threatening cardiovascular events during the acute phase of hypertensive disorders.鈥�
By focusing on immediate and short-term cardiovascular risks during pregnancy and the early postpartum period, this study aligns with the World Health Organization鈥檚 recommendations to reduce maternal morbidity through improved pregnancy and postpartum care.
Bridging perspectives
Dr. Malham茅鈥檚 perspective on this research is informed by her experience as an obstetric internist.
鈥淭his study reflects an effort to bridge the gap between how hypertensive disorders of pregnancy are traditionally viewed in obstetrics and how cardiovascular conditions are approached in internal medicine,鈥� she says. 鈥淭he patients we care for during delivery, who face acute cardiovascular complications, inspire this team鈥檚 commitment to developing better preventive strategies. By understanding the risk factors, we can work towards anticipating patients鈥� specific health care needs and preventing these events.鈥�
鈥淚 am proud to be part of this study, which exemplifies the vital connection between obstetric medicine and cardiovascular disease,鈥� says Dr. Stella Daskalopoulou, Co-director of the CHAL Program at The Institute. 鈥淭his intersection highlights how maternal health influences cardiovascular outcomes and underscores the importance of integrated care and research strategies. Advancing our understanding of pregnancy-related cardiovascular risks is central to the CHAL Program鈥檚聽mission to improve maternal and cardiovascular health.鈥�
Implications for clinical care and future research
The study identified a graded trend: as the severity of HDP increases, so does the risk of cardiovascular complications. These findings underscore the urgent need for precise, individualized care strategies during the peripartum period, particularly for individuals with HELLP syndrome.
While long-term cardiovascular risks for individuals with a history of HDP remain a concern, this study highlights the pressing need for prompt interventions. Future research will focus on identifying mechanisms and strategies to mitigate acute cardiovascular risks in the context of HDP. To this end, Dr. Malham茅 will be a Principal Investigator co-leading a research pillar in the聽Canadian Network of Networks to Reduce Cardiovascular Mortality and Morbidity in Pregnancy听(), Nominated Principal Investigator Dr. Rohan D鈥橲ouza). This is one of two Research Networks of Excellence in Women鈥檚 Heart and/or Brain Health to have received a $5聽million grant from Heart and Stroke, Brain Canada, and the Canadian Institutes of Health Research 鈥� Institute of Gender and Health.
About the study
聽by Isabelle Malham茅, Kara Nerenberg, Kelsey McLaughlin, Sonia M. Grandi, Stella S. Daskalopoulou, and Amy Metcalfe was published in聽JAMA Network Open聽on Oct 3, 2024.
doi:10.1001/jamanetworkopen.2024.36478