The condition, more severe than preeclampsia, should inspire close follow-up for hypertension, heart failure, and stroke.
Women whose pregnancies are complicated by eclampsia, a rare but serious condition, are at much higher risk of developing CVD in the year after pregnancy, new data show.
For lead researcher Jessica C. Fields, MD (Christiana Care Health Services, Newark, DE), the findings justify careful monitoring of patients with eclampsia in the year after delivery.
“I hope that patients who are pregnant, who have hypertensive disorders or not, are followed more closely if they do end up having eclampsia, . . . because from this research we know that there are significant potential effects on cardiovascular disease,” she told TCTMD. While their study didn’t extend beyond 1 year, added Fields, patients who’ve had eclampsia likely benefit from lifelong follow-up.
Study after study has pointed to the added cardiovascular risk that accompanies preeclampsia and other hypertensive disorders of pregnancy, which can linger for decades across a woman’s lifespan. Far less is known, however, about eclampsia.
One reason for this, Fields said, is that eclampsia occurs so infrequently—in these US data, fewer than one in 100 pregnancies were affected.
Most research on the topic has “lumped preeclampsia with eclampsia,” with the idea that one condition preceded the other, senior author Cande V. Ananth, PhD, MPH (Rutgers University, New Brunswick, NJ), explained. However, this is not the case—the two conditions exist on the same spectrum but differ in key ways.
Preeclampsia has hypertension as its hallmark symptom. Eclampsia, which is more severe, is characterized mainly by seizures, with around a quarter of patients being normotensive, and importantly, it may or may not be preceded by preeclampsia. Both conditions elevate women’s risk of cardiovascular complications, though eclampsia is the more potent of the two.
Initially, the investigators had thought “perhaps the risk of cardiovascular disease in people who have eclampsia was transient, [occurring] between delivery and maybe up to a year,” said Ananth. “So we looked at specific time intervals after delivery.” Although the risk decreased slightly, “it wasn’t appreciable,” he added. “Even at the end of 1 year, you still see a very high risk of cardiovascular disease in patients, almost eight-to-ninefold increased risk.”
The results were published online recently in the European Heart Journal.
CVD Readmissions Rise by Sevenfold
More than 27 million births occurred at US hospitals between 2010 and 2018, yet just 20,478 of those deliveries—74.7 per 100,000—involved eclampsia.
Using the Nationwide Readmissions Database, Fields et al found that in the first year after delivery, 854 per 100,000 women with the complication returned to the hospital for CVD, an umbrella that included ischemic, atherosclerotic, and hypertensive heart disease, as well as acute MI, heart failure (HF), cardiomyopathy, and cardiac arrhythmias. In contrast, 147 per 100,000 normotensive patients had CVD readmissions within 1 year (adjusted HR 6.9; 4.5-10.4).
The risk level varied among CVD types, with notable increases in hypertensive heart disease (adjusted HR 15.5, 95% CI 7.9-30.2) and HF (adjusted HR 7.6, 95% CI 4.7-12.5) readmissions for women who’d developed eclampsia. Stroke readmissions also were elevated after the complication (adjusted HR 12.6, 95% CI 6.9-22.8).
Even within the first month following delivery, eclampsia was linked to greater risk of CVD complications, the investigators point out, adding that the “data highlight the need for targeted short-term follow-up.”
Additionally, compared with preeclampsia, eclampsia carried higher 1-year risks of CVD (adjusted HR 1.6; 95% CI 1.1-2.5) and stroke (adjusted HR 3.2; 95% CI 1.7-6.0).
Fields and colleagues hope their results will inspire a change to clinical guidelines. The 2018 American College of Cardiology and American Heart Association cholesterol guidelines, for example, identify preeclampsia as a risk factor for CVD and endorse statin therapy for patients at borderline-to-intermediate risk, they point out.
Other recommendations, including from the American College of Obstetricians and Gynecologists, the Society for Maternal-Fetal Medicine, and the American Stroke Association, “all call for close monitoring in the postpartum period for people who have had preeclampsia, gestational diabetes, [or] preterm delivery,” added Ananth. “ We believe that eclampsia should be added to that list as a standard recommendation.”
The next step, he said, will be to look over a longer time horizon to see how the link between eclampsia and CVD evolves across decades of a woman’s life after pregnancy.