Earlier screening needed after pregnancy with pre-eclampsia as European study shows 4x heart attack risk

Pre-eclampsia is a combination of raised blood pressure and often protein in the urine or problems with the kidneys or liver during pregnancy. It can range from mild to severe, with mild pre-eclampsia affecting up to 6% of pregnancies, and can lead to serious complications for mother and baby. 

Scientists in Denmark analysed national registers to identify all pregnant women in Denmark between 1978 and 2017 and grouped them by whether they did not have pre-eclampsia, or whether one or more pregnancies had been complicated by pre-eclampsia. 

Their analysis shows that women with pre-eclampsia have a higher likelihood of heart attack and stroke within 7 years of having a baby, and the risks are still elevated more than 20 years later. 

This research backs Tommy’s recent calls for an increased focus on women and pregnant people at risk of pre-eclampsia during pregnancy, following a BMJ report last year showing higher rates of maternal death in the UK compared to other European nations, including a rising number of deaths from pre-eclampsia. 

Despite huge advances in developing new tests and treatments, this BMJ report showed a 4x increase in pre-eclampsia deaths in the UK in 2020. We know that with careful monitoring and management many of those deaths would have been avoidable.   

We also know that with proper identification and treatment most women who have pre-eclampsia in pregnancy go on to have positive pregnancy and birthing experiences.  

As the Head of Tommy’s Preterm Birth Surveillance Unit Professor Andrew Shennan and colleagues, wrote in the BMJ last year, these concerning statistics underline the importance of women’s cardiovascular health “and the need to develop strategies before, during, and after pregnancy to prevent the morbidity and mortality these problems can cause." 

What the study from Denmark found 

Writing in the European Journal of Preventive Cardiology the research team explain that high risk of cardiovascular disease after pre-eclampsia can appear at young ages and early after having a baby.  

Women with pre-eclampsia were 4 times more likely to have a heart attack and 3 times more likely to have a stroke within 10 years of delivery than those without pre-eclampsia.  

More than 20 years after giving birth, the risk of heart attack or stroke was still twice as high in the pre-eclampsia group compared to the non pre-eclampsia group. 

Women aged 30 - 39 years with a history of pre-eclampsia had a 5x higher rate of heart attack and 3x higher rate of stroke than those of a similar age with no-preeclampsia. A raised likelihood of heart disease in those with a history of pre-eclampsia continued throughout adulthood, with women over 50 still at double the risk. 

What this means 

This research shows the importance of more research into understanding pregnancy complications and how they affect a mother’s health. It also supports Tommy’s view that we need to take a ‘whole life’ approach to women and birthing people’s health and use information about conditions and complications in pregnancy to develop personalised care pathways and help predict and potentially prevent future life-changing or life-limiting conditions. 

Tommy’s midwife Tina says: 

This vital research builds on what we know about pre-eclampsia and cardiovascular risk and shows how important surveillance is to prevent heart attacks and stroke in women who have had pre-eclampsia. We can’t wait until older age when they become eligible for heart screening programmes – now we know how raised the risk is for women in their 30s, and so soon after birth, women at risk must be identified and screened earlier. 

It’s well known that pre-eclampsia predisposes women to have a higher likelihood of heart disease later in life, but the Danish study is the first to examine how soon after pregnancy heart attacks and stroke can happen, as well as showing the scale of risk in different age groups. 

This study also supports Tommy’s Lancet research which showed a link between recurrent miscarriage and cardiovascular disease, again showing how vital a holistic approach to research is for advancing our understanding and developing diagnostic tools and treatments which could save mothers’ and babies’ lives. 

Better diagnosing and treating pre-eclampsia 

At Tommy’s our researchers have been working hard to understand why pre-eclampsia happens, how to identify women at risk, and how the condition can be prevented.  

Researchers from our London and Manchester centres were part of the SCOPE study team, an international effort looking at how to predict and prevent the major diseases of late pregnancy: pre-eclampsia, preterm birth and fetal growth restriction. 

Our PARROT trial was then key to the development of a simple blood test which screens for pre-eclampsia. The new PlGF (placental growth factor) test speeds up diagnosis and is particularly effective at determining which women are most at risk of developing the severest form of pre-eclampsia.  

In March 2022 new draft guidance from NICE recommended the test’s use by the NHS for women between 20 to 36 weeks and 6 days of pregnancy to help make decisions about the care of women and birthing people’s care if they were suspected to have pre-eclampsia. Testing had previously only been recommended by NICE for use to help rule the condition.