Do Preeclampsia and Breastfeeding Affect CV Risk Factors?

Women who breastfeed for at least six months after giving birth may reduce their cardiovascular risk factors, whereas women who have preeclampsia during pregnancy may be more likely to develop cardiovascular risk factors after several years, according to two separate studies that will be presented at ACC.18 in Orlando.

For the first study, Malamo Countouris, MD, and colleagues recruited 678 women between 1998 and 2004 who were pregnant at the time they enrolled in the study. The women participated in a follow-up health assessment seven to 15 years later. During the follow-up, participants reported how long they had breastfed after each pregnancy, and blood pressure, cholesterol, triglycerides, and the diameter and thickness of the carotid artery were measured.

Results showed that compared with women who had never breastfed, those who had normal blood pressure during pregnancy and had also breastfed for six months or longer had significantly higher levels of HDL, lower triglycerides, and healthier carotid artery thickness. There was no evidence of cardiovascular benefit from breastfeeding for women who had high blood pressure during pregnancy.

Although the researchers are unsure why breastfeeding for at least six months per pregnancy seems to reduce cardiovascular risk factors, Countouris suggested that the hormone oxytocin, which increases during breastfeeding, could lower blood pressure. Breastfeeding might also counteract some of the metabolic changes that occur during pregnancy, the researchers said.

"There's a lot we still don't understand about the accumulation of cardiovascular risks in women," said Countouris. "Examining how pregnancy may increase or perhaps mitigate some of that risk can give us insights into the unique presentation and development of heart disease risk in women."

In a separate study, Karlee Hoffman, DO, et al., examined whether women diagnosed with preeclampsia during pregnancy were more likely to develop high blood pressure, diabetes or high cholesterol within five years. Researchers analyzed the health records of more than 650 women who were pregnant between 2009 and 2015, half of whom had been diagnosed with preeclampsia.

Results showed that in the five years following delivery, women with preeclampsia were more likely to develop high blood pressure (32.8 percent vs. 0.3 percent), new-onset diabetes (21 percent vs. zero), and high cholesterol (3 percent vs. zero). In addition, of the women who followed up with a primary care physician after receiving a preeclampsia diagnosis, only one patient's chart noted the diagnosis and mentioned long-term monitoring for cardiovascular disease. Women with preeclampsia who were African-American, older at the time of pregnancy, or who had a history of high blood pressure or diabetes had an especially elevated risk of high blood pressure, Hoffman said.

"We need to work with our obstetrics and gynecology colleagues to capture these patients and refer them to a primary care doctor or a cardiologist for more rigorous follow up to help prevent future cardiovascular disease," Hoffman said.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Noninvasive Imaging, Prevention, Hypertriglyceridemia, Lipid Metabolism, Nonstatins, Echocardiography/Ultrasound, Hypertension

Keywords: ACC18, ACC Annual Scientific Session, Female, Pregnancy, Blood Pressure, Risk Factors, Gynecology, Pre-Eclampsia, Oxytocin, Obstetrics, Cardiovascular Diseases, Physicians, Primary Care, Breast Feeding, Carotid Intima-Media Thickness, Follow-Up Studies, Triglycerides, Hypertension, Diabetes Mellitus, Lipoproteins, HDL, Carotid Arteries, Cholesterol, Heart Diseases, Primary Health Care

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