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Megan mazaika5/1/2023 9Īlthough our understanding of the pathophysiology of PE has increased dramatically in the past 30 years, the precise mechanisms underlying this condition are still emerging. 2 According to the most recent definition endorsed by the International Society for the Study of Hypertension in Pregnancy, PE is defined as new-onset hypertension (systolic >140 mmHg and diastolic >90 mmHg) accompanied by one or more other features: proteinuria, other maternal organ dysfunction (including the liver, kidney, and nervous system), or hematological involvement, and/or uteroplacental dysfunction, such as fetal growth restriction and/or abnormal Doppler ultrasound findings of uteroplacental blood flow. PE is classically defined as new-onset hypertension and proteinuria developing in the second half of pregnancy and resolving after delivery, yet it is multiorgan HDP that can present with systemic manifestations ( e.g., elevated liver enzymes and low platelets) even before the development of proteinuria. New advancement in the pathogenesis of HDP We also review follow-up care models and recommend strategies for implementing these models into clinical practice. We also discuss opportunities for counseling, planning, and interventions to optimize treatments for underlying medical conditions associated with increased CV risk to improve pregnancy outcomes and long-term CV health. We explore how risk prediction using biomarkers could potentially facilitate stratification of antenatal care and testing of potential preventative and therapeutic interventions. We highlight advances in understanding the emergence of CV conditions during pregnancy and postpartum (specifically hypertensive disorders of pregnancy and peripartum cardiomyopathy ) and their association with CV risk over the life course. Thus, a critical life span perspective in assessment of women's CV risk factors is needed. Equally important and similarly understudied is the concept that women's long-term CV health could be detrimentally affected by adverse pregnancy outcomes (APOs), such as preeclampsia (PE), gestational hypertension, and diabetes, and preterm birth. 1 The question remains whether substantial physiological stress on the cardiovascular (CV) system during pregnancy-reflected in hemodynamic, hematological, and metabolic changes-uncovers subclinical prepregnancy CVD in otherwise healthy women. Causes of maternal mortality are multifaceted, and in the United States, cardiovascular disease (CVD) is the primary cause of pregnancy-related mortality. The maternal mortality rate is rising in the United States even as rates decrease globally. In this review article, we highlight new advancements in understanding adverse, pregnancy-related CV conditions and will discuss promising strategies or interventions for their prevention, diagnosis, and treatment. Thus, a critical life span perspective in the assessment of women's CV risk factors is needed to help women and health care providers recognize and appreciate not only optimal CV health but also risk factors present before, during, and after pregnancy. Equally important and similarly understudied is the concept that women's long-term CV health could be detrimentally affected by adverse pregnancy outcomes, such as preeclampsia, gestational hypertension, and diabetes, and preterm birth. The question remains whether substantial physiologic stress on the CV system during pregnancy reflected in hemodynamic, hematological, and metabolic changes uncovers subclinical prepregnancy CVD in these otherwise healthy women. Paradoxically, women with no preexisting chronic conditions or risk factors also experience significant pregnancy-related cardiovascular (CV) complications. Women who are African American or American Indian/Alaskan Native, have HDP, are medically underserved, are older, or are obese have a major risk for the onset and/or progression of CVD during and after pregnancy. Cardiovascular disease (CVD), including hypertensive disorders of pregnancy (HDP) and peripartum cardiomyopathy, is a leading cause of pregnancy-related death in the United States.
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