Cardiometabolic Antecedents of Preeclampsia

In this chapter, we advance the concept that maternal cardiometabolic factors interact with placental factors to promote inflammation, endothelial cell dysfunction, and the maternal preeclampsia syndrome. We also summarize evidence suggesting that the same underlying factors that contribute to preeclampsia also increase a woman's risk of developing cardiovascular disease (CVD) in later life. The majority of data on candidate factors contributing to preeclampsia have been retrospective in nature, relying on measurements conducted either in early pregnancy, prior to onset of clinical symptoms of preeclampsia, or months to years postpregnancy after clinical symptoms of preeclampsia have resolved (and in the absence of a placenta). Because of the logistical difficulties of recruiting preconception cohorts of women, few studies have investigated cardiovascular risk factors before pregnancy in relation to risk of preeclampsia. Nevertheless, a substantial body of literature on prepregnancy cardiometabolic antecedents of preeclampsia is now available. This updated chapter therefore surveys the available data on cardiometabolic risk factors before conception in relation to risk of preeclampsia. There is evidence for prepregnancy factors potentially related to, and unrelated to, the metabolic syndrome consistent with a heterogeneous etiology of preeclampsia. These data support the hypothesis that chronic, underlying factors present before pregnancy, including metabolic and cardiac antecedents, contribute to both risk of preeclampsia and risk of later-life CVD.