Cardiometabolic risk after pregnancy with placental dysfunction: intensified versus conventional follow-up care - a feasibility study.

• Applicant: Dr. Anne Dathan-Stumpf
• Subject Area: Gynaecology and Obstetrics
• Term: since 2022
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 509059336

Preeclampsia (PE), pregnancy induced hypertension and chronic hypertension can be summarized as hypertensive pregnancy disorders and are the leading causes of maternal and fetal morbidity and mortality worldwide. The intrauterine growth restriction, which is characterized as non-achievement of the genetically predetermined growth potential and correlates to an additive fetal as well as neonatal morbidity and mortality, also belongs to the group of placental dysfunction. For all of these pregnancy complications a placental "anti-angiogenic status" is the most relevant pathogenetic factor. Numerous studies show that hypertensive pregnancy disorders are correlated with an increased risk for short and long-term cardiovascular diseases. Studies have shown that after PE, the vascular age is almost two decades above the actual calendar age and is associated with a significantly poorer cardiovascular health. In addition, preeclampsia is associated with cardiac structural changes, which can be detected postpartum within one to three years. Regardless of the presence of gestational diabetes, PE correlates with a two- to three-fold increased risk of developing diabetes mellitus postpartum, dyslipidemia and a six-fold increased risk of terminal kidney failure.Despite the well-known high-risk profile associated with a significantly higher mortality, there are neither structured follow-up care programs for women with hypertensive pregnancy diseases nor recommendations on the methodology or the most favorable time for intervention. Only around 20% of the patients with hypertensive pregnancy disorders see a family physician six months postpartum, partly due to a lack of awareness of the cardiovascular complications after hypertensive pregnancy. In a systematic review which summarized 16 national and international guidelines for follow-up care after hypertensive pregnancy diseases, only 50% formulated recommendations after the immediate post-partum period (within 12 weeks postpartum).There is a need for future studies in women with a history of hypertensive pregnancy disorders in order to devise an aftercare program and define candidates for biomarkers to develop screening, risk stratification and preventive measures to reduce the significant cardiovascular risk. It is currently unclear how many women can be recruited for such an aftercare program in the long term and how good compliance with the intensified care is going to be. Therefore, a feasibility pilot study is necessary in order to ensure that compliance with is adequate and to be able to select an appropriate primary endpoint for a subsequent multicenter effectiveness study and to estimate its effect size. Therefore, this study will examine primarily the feasibility and secondarily the benefit of an early diagnosis and treatment of cardiovascular risk factors within two years after delivery in order to prevent long term cardiovascular diseases.

• DFG Programme: Clinical Trials
• Co-Investigator: Professor Dr. Holger Stepan