Cardiovascular risk and pre eclampsia

[Greycloudsbrightskies]

Hello, I've had three pregnancies and had pre eclampsia in all of them. I've been reading about the long term increased risks of cardiovascular disease, heart attacks and strokes and feel quite worried. While I am doing everything I can to mitigate my risks, they're still there.

Anyone have any particular knowledge or experience with this?

Not knowledge rather anecdata: I had pre eclampsia and I have heart disease/high BP and had a heart attack at age 51.

Thank you for sharing @Swansandcustard and I'm sorry to hear about your heart attack. Did you know about your risks prior to diagnosis with heart disease/high BP? When you had the heart attack, did the doctors make a correlation with the pre eclampsia?

No I had no idea, and they weren’t really fussed about the pre eclampsia

Your history is now a non-modifiable risk for CVD and CVA, the same as a strong family history would be. It absolutely sucks but all you can is address any other risk factors eg. diet, weight, activity, alcohol, drugs, stress etc. As well as a BP check annually in line with guidance for women who've had PE or PIH.

I don't think it's absolutely clear whether the endothelial dysfunction aspect of PE (and possibly PIH) leaves long term damage that raises the risk of heart disease and stroke, or whether having PE or PIH hastens what would've happened to us in older age anyway.

I chose to stay on an ACE inhibitor after delivery this time. It's cardio-protective and any points shaved off my BP reduce my longer term risk. My BP was much worse, much sooner second time around. It spiked again post delivery despite being on a fair whack of labetalol at the time.

Sometimes I feel it's all unfair and I get a bit down over having a complicated pregnancy and being on BP meds at 40, but not so long ago I'd perhaps have been a mortality statistic instead.

Depressing isn’t it. I had p/e in 2007. And strong family / female line history of strokes

i think all you can do is follow the advice given. Although tbh the doctors don’t seem very bothered. Had bp checked 2008 after bp meds stopped post birth and no one’s ever even mentioned it since
had bp checked with subsequent pregnancy but not since

I had pre eclampsia with all 3 . I'm now on blood pressure tablets and statins.

Thanks @Nibblonian that's really informative, I appreciate everything you've shared. That's interesting and very depressing that it's a non-modifiable risk.

Are you continuing on ACE inhibitors to reduce this risk, or because your BP remained high? I was on them for a couple of months after my last delivery as my BP was very high post delivery as well. I am now (nearly a year after third baby and third round of pre eclampsia) off all medication and my BP has settled but at the high end of normal.

It does feel unfair. And I am already a non smoker/normal BMI etc etc so I don't know what else I can do. Obviously during the three pregnancies and post partum periods the focus was on the immediate health of me and the baby, so I don't feel I asked enough questions to get the information I needed about the long term risks.

@GettingStuffed are you on the medication because your BP stayed up after having PE or as a precautionary measure?

Thanks everyone for sharing. It's good to be able to discuss this as I've been feeling very worried and there's nobody really to discuss it with. Don't think the doctor would be interested in something that's not a health problem right now

@Greycloudsbrightskies We sound very similar. Yes, settled about the high end of normal after dropping pretty low on labetalol and enalapril a few weeks after delivery. I came off labetalol super slowly this time. GP and I agreed it wasn't doing harm, and arguably doing good, to reduce my BP to <120/80 with a small dose of enalapril given my history.

It's all left me with a real fear of having my BP measured now though which doesn't help at all!

I had pre-eclampsia and HELLP with my first DC and this is something that really worries me. I had no follow up care after the birth.

@Nibblonian those were the same drugs I had post delivery, with some nifedipine too! I think I'll make an appointment with the GP to discuss whether some medication to keep my BP at the middle or lower end of normal might be a good idea.

How do you manage your worries about cardiovascular disease/heart attack etc in the future?

I felt a bit alone knowing how to come of the medications this time as I had a different GP on the phone each time and I was desperate to come off the drugs. With hindsight I worry I did even more damage.

And yes to the worry about having BP done! The sound of the machine brings back all the worries of the time!

@Dibblydoodahdah it is strange that it is a known risk but they don't give you any guidance on this. I found out about it from looking stuff up after it was mentioned in passing by a doctor in the hospital

@Greycloudsbrightskies I had my first DC 12 years ago so I don’t know whether it was recognised back then. However, there was no follow up care or advice for subsequent pregnancies. In fact, my DH had to demand that they take my blood pressure on the post natal ward as I was still feeling very unwell after the birth. It was as though once DS was born, they thought that was the end of it!

@Greycloudsbrightskies We sound beyond similar now 😂 Yep, sights and sounds will set it off for me too. My son has a little squeezy toy that sounds like a BP cuff being inflated. I absolutely think there is a trauma element to this for many women. It's incredibly scary at the time and you don't process it as well as you otherwise might we're you not exhausted and caring for a newborn.

I had a length chat with a doctor before leaving hospital after my postnatal readmission. I had a long list of questions! They advised that once you hit about 6 weeks after delivery the immediate and most concerning risks associated with BP problems in pregnancy reduce significantly. You become something of a bog standard hypertensive. The perinatal period puts a huge amount of strain on the body, much more so for some unfortunately. It's been suggested that PE is an immunological response to pregnancy and that BP is so dangerous during this time because the pregnant body can't tolerate the extremes that a non-pregnant body can. Not for very long anyway.

I am a worrier and can get really carried away thinking about what might happen in the future. I've dropped 20kg from delivery weight, don't drink, don't smoke. Exercise and stress are things I need to work on. I try to be pragmatic about it and tell myself I'm managing a known risk by taking medication. Which to me is better than failing to manage an unknown risk.

I had PE & HELLP in 2008/9 in my 1st pregnancy - very severe & very early (DS was a 29-weeker).

I'm now in my early 50's & this is a reminder that I should go & get a BP check.& cholesterol done.

My mum had a quadruple bypass at 54 due to heart disease.

I try to look after myself but am a stressed single parent working full-time in the NHS. Have gained a lot of weight but run 5K's regularly.

I do worry about the future......

@Nibblonian that's really well expressed about the trauma - definitely how I felt/feel, that I didn't really have the time and space and energy to process it all because you're looking after a tiny newborn! And also the relief and happiness of the new baby eclipses everything so it can be hard to physically and mentally get over it.

It's very hard from reading things to get a clear understanding of the extent of the risk and the various factors at play. From what I've looked at it seems that there is the increased risk of cardiovascular problems from the increased risk of hypertension but also increased risk of cardiovascular problems because of damage that has been done to the vessels and heart etc during the pre eclampsia. It's this second one that worries me the most as I feel it's completely out of my control. Whereas the hypertension risk I feel I can reduce as much as possible and if I keep an eye on my BP then I can go on medication as soon as needed rather than spending years with damaging BP and not knowing.

Thank you for sharing a little of how you cope with the worry. Your rational and pragmatic approach seems like the best way to handle it. I'm going to do some regular BPs for a couple of weeks then talk to the doctor. Yes I'm the same, BMI and diet are fine and I don't smoke and don't drink much. But exercise and stress are the two I need to sort out too. When feeling positive about it all I think that perhaps in a way it's good, as I know my risk so can reduce all the factors in my control. But that only works if accepting the theory that the predisposition was already there and the strain on the body of pregnancy just exposed it..doesn't work with any of the other and many theories about pre eclampsia!

@ProseccoOnIce thank you for sharing your experience. That sounds really severe and scary, I hope you and your baby recovered and got back to health quickly.

Good luck for the BP and cholesterol checks, I'm glad this thread has been a reminder!

Sometimes it does feel a bit unfair that with this risk there's a need to take care of ourselves to reduce any other risk factors. But on the flip side there are all the other health benefits to gain from taking care of these things.

So I'm mid 50s. As far as I know I didn't get pre eclampsia but my mum did and that I believe can cause problems in later life for the child as far as CV risk. Fast forward half a century and I have high bp and possibly though not confirmed small vessel disease to my heart (common in menopausal women). I ran regularly for years, normal bmi, never smoked but very stressful job ! DM also ended up with high bp and vascular dementia in her mid 70s despite being very fit for years.
Only consolation is that my HBP was picked up earlier.
Funnily enough both my own DS were small and DS2 possibly had IGR but never confirmed on scans. There were also issues with the placenta and umbilical cord (long but thin) which I believe in itself can be a risk factor for pre eclampsia....

That's interesting @Samphiredragonfly
It's crazy that it also becomes a risk factor for the children born to pre eclamptic mothers. With my first child I thought once the baby was born that was it, pre eclampsia gone and forgotten! It's quite a damaging disease

That is interesting. My mum had pre-eclampsia with me. I understand that’s now classed as a risk factor and I would now be advised to take baby aspirin even with my first child. I was advised to take it when I got pregnant again with ny second.

Hi - I posted on the general health thread. I had elevated BP at the end of my pregnancy with DS1 and am ashamed to admit I don't know the difference between that and actual pre-eclampsia: interested in any guidance!

More generally, I think after care for women is awful. I had my BP taken at my 6 week check and was sent on my way.

Yes it's linked. I had preeclampsia with my first pregnancy and blood pressure has been slightly higher since. My mum also had it who was also slim at the time. Her dad died of a massive heart attack in his mid 60s (slim and fit) and her brother recently had a stroke in his early 50s. My mum doesn't seem to have high blood pressure anymore but who knows what could happen in a few years. Not much you can do apart from monitor your BP and eat well and keep your weight down.

I think the PE can almost fast forward issues you would have had in old age anyway.