Epidemiological evidence from both national and international cohorts has consistently demonstrated strong associations between preeclampsia and increased ongoing risk of cardiovascular and metabolic disease for affected women. Risks (compared to women after normotensive pregnancy) include at least doubled chance of ischaemic heart disease, cardiovascular death, and stroke, doubled rate of Type 2 diabetes even when the preeclamptic pregnancy was not complicated by gestational diabetes, and five-fold increase in end-stage renal disease. These increases in relative risk are present within 5-10 years of an affected pregnancy, continue lifelong, and persist after adjustment for confounding factors. Risks after gestational hypertension appear similar. Adverse cardiometabolic outcomes are further increased in women with preterm preeclampsia, recurrent preeclampsia, and other cardiovascular risk factors such as smoking.
Pregnancy complicated by hypertensive disorders therefore represents an important opportunity to identify young women at increased risk of cardiovascular disease and implement measures to improve their lifelong health, such as lifestyle behaviour change. However, postpartum follow-up of these women remains largely ad-hoc, and few studies have examined early intervention programs. This talk will review the evidence around health risks and how to improve women’s health after hypertensive pregnancy, as well as the evidence gaps to be filled moving forwards.