What can pre-eclampsia reveal about long-term cardiovascular health?

For many women expecting their first child, pre-eclampsia emerges as an unexpected and unsettling complication, casting a shadow over late pregnancy. While its immediate effects are concerning, the condition also carries long-term health risks that persist beyond childbirth. Read on to discover how research is shedding light on this complex and still not fully understood pregnancy disorder.
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Pre-eclampsia is one of the major challenges of maternal healthcare

Previously known as toxemia of pregnancy, it is a potentially dangerous condition that can progress to eclampsia and affects 2–6% of first-time pregnancies. It manifests as high blood pressure, fetal growth restriction, and proteinuria. In most developed countries all pregnant women are actively screened for it in maternity clinics. In Finland, the outlook for both mother and baby is generally good thanks to high-quality specialized healthcare, but the situation is very different in many countries. While risk factors such as first pregnancy, lifestyle, high blood pressure, obesity, and diabetes are well known, the exact causes of pre-eclampsia remain largely unclear, making it difficult to predict who will develop the condition.

The pathogenesis of pre-eclampsia remains poorly understood

Similar conditions are rarely seen in the animal kingdom—only a few primate species are known to experience a comparable pregnancy disorder. It has been suggested that pre-eclampsia is a byproduct of humans’ long gestation period, during which the fetus requires a high supply of nutrients from the mother, particularly to support cognitive development. This, in turn, demands optimal functioning of the placenta. The disorder is primarily linked to placental dysfunction—pre-eclampsia resolves only when the placenta is removed, often necessitating an early delivery with its associated complications.

In our recently published study, we combined large datasets, including data from the FinnGen project, to examine 17,000 mothers who had experienced pre-eclampsia and compare them to 300,000 healthy women who had given birth. We identified nine genetic regions associated with the condition. Many of the implicated genes have previously been linked to kidney diseases, immune system dysfunctions, the development of blood vessels in the uterus and placenta, and more broadly to cardiovascular diseases. These findings highlight the heterogeneity of pre-eclampsia but also emphasize its strong connection to cardiovascular health.

Pregnancy is a window into a family’s future cardiovascular health

In our previous studies, we found that genetic susceptibility to high blood pressure significantly increases the risk of developing pre-eclampsia. If we can better integrate genetic predisposition with traditional risk factors, we may move toward more personalized medicine in managing the condition. This could lead to enhanced monitoring for those at high risk, early initiation of low-dose aspirin to reduce the risk of pre-eclampsia, and, if necessary, blood pressure medication during pregnancy.

Our ongoing research, along with previous studies, has shown that experiencing pre-eclampsia more than doubles the risk of developing cardiovascular disease before the age of 60. The elevated risk appears to persist at least until the age of 80. If a mother has both a history of pre-eclampsia and a high genetic predisposition to cardiovascular diseases, her risk of developing heart disease in the decades following pregnancy is particularly high. However, this increased risk is not limited to mothers—children born from pregnancies affected by pre-eclampsia have also been found to have a higher likelihood of developing cardiovascular disease. The genetic basis of this association is being investigated in our ongoing project funded by the Academy of Finland.

Improving outcomes with predictive models and lifestyle interventions

Fortunately, future heart health can be improved through a healthy lifestyle—and for many, having a child provides a natural moment to reflect on personal habits. For example, the FINNCARE project is investigating whether long-term lifestyle interventions can lead to positive changes in the cardiovascular health of families affected by pre-eclampsia.

Our research group at Tampere University also contributed to the development of the first pre-eclampsia Käypä hoito (Current Care, in Finnish only) guideline, which helps Finnish healthcare professionals provide guidance to affected women on cardiovascular disease risk and prevention. Next, we aim to evaluate whether a follow-up form given to mothers upon discharge from the maternity hospital is perceived as useful and whether it has an impact on cardiovascular risk factors one year after childbirth.

It is important that women who have experienced pre-eclampsia are aware of their ability to influence their own and their family’s long-term health. Encouraging affected individuals toward a more active lifestyle and a healthier diet can help improve future cardiovascular health. If our research also improves the ability to predict pre-eclampsia, we can enhance the chances of successful pregnancies.

Author:

Jaakko Tyrmi

University of Oulu / Tampere University

Additional reading:

Study on genetic background of pre-eclampsia:

https://pubmed.ncbi.nlm.nih.gov/37285119/

A study examining the genetic link between cardiovascular diseases and pre-eclampsia:

https://pubmed.ncbi.nlm.nih.gov/35862124/