Study highlights the need for enhanced cardiovascular care during pregnancy
SOURCE: Research Institute of the McGill University Health Centre (The Institute)
December 13, 2024
A new study has uncovered critical insights into the connection between hypertensive disorders of pregnancy (HDP) and life-threatening cardiovascular complications during delivery. Published in JAMA Network Open, the research highlights how the severity and type of HDP—such as chronic hypertension, preeclampsia, and HELLP syndrome—significantly impact health risks for pregnant individuals.
The study, led by Dr. Isabelle Malhamé, Scientist in the Cardiovascular Health Across the Lifespan (CHAL) Program at the Research Institute of the McGill University Health Centre (The Institute), was conducted together with Dr. Stella Daskalopoulou, the Co-director of the CHAL Program at The Institute, Dr. Kara Nerenberg and Dr. Amy Metcalfe from University of Calgary, and Dr. Kelsey McLaughlin and Dr. Sonia Grandi from University of Toronto.
With maternal morbidity rising across North America, cardiovascular complications such as pulmonary edema and stroke are among the leading causes of pregnancy-related mortality. The findings from Dr. Malhamé and her team emphasize the importance of personalized care for individuals with HDP to mitigate severe health risks during delivery and in the postpartum period.
“It is important to understand the association between hypertensive disorders and serious maternal complications occurring during or shortly after pregnancy,” says Dr. Malhamé. “We sought to better understand how the type and severity of HDP influence the risk of cardiovascular complications, paving the way for improved care strategies tailored to each patient’s needs.”
Key findings: HDP severity and cardiovascular risks
The study demonstrated that the type and severity of HDP—ranging from chronic hypertension and preeclampsia to HELLP syndrome— significantly influenced the risk of cardiovascular complications. Drawing on data from a population-based cohort study of more than 15 million deliveries, the research revealed that HELLP syndrome, the most severe form of HDP, showed the strongest association with cardiovascular complications at delivery.
“Our group is particularly focused on developing methods to prevent acute cardiovascular complications related to HDP,” explains Dr. Malhamé. “This research highlights the critical need for better risk stratification to prevent potentially life-threatening cardiovascular events during the acute phase of hypertensive disorders.”
By focusing on immediate and short-term cardiovascular risks during pregnancy and the early postpartum period, this study aligns with the World Health Organization’s recommendations to reduce maternal morbidity through improved pregnancy and postpartum care.
Bridging perspectives
Dr. Malhamé’s perspective on this research is informed by her experience as an obstetric internist.
“This study reflects an effort to bridge the gap between how hypertensive disorders of pregnancy are traditionally viewed in obstetrics and how cardiovascular conditions are approached in internal medicine,” she says. “The patients we care for during delivery, who face acute cardiovascular complications, inspire this team’s commitment to developing better preventive strategies. By understanding the risk factors, we can work towards anticipating patients’ specific health care needs and preventing these events.”
“I am proud to be part of this study, which exemplifies the vital connection between obstetric medicine and cardiovascular disease,” says Dr. Stella Daskalopoulou, Co-director of the CHAL Program at The Institute. “This intersection highlights how maternal health influences cardiovascular outcomes and underscores the importance of integrated care and research strategies. Advancing our understanding of pregnancy-related cardiovascular risks is central to the CHAL Program's mission to improve maternal and cardiovascular health.”
Implications for clinical care and future research
The study identified a graded trend: as the severity of HDP increases, so does the risk of cardiovascular complications. These findings underscore the urgent need for precise, individualized care strategies during the peripartum period, particularly for individuals with HELLP syndrome.
While long-term cardiovascular risks for individuals with a history of HDP remain a concern, this study highlights the pressing need for prompt interventions. Future research will focus on identifying mechanisms and strategies to mitigate acute cardiovascular risks in the context of HDP. To this end, Dr. Malhamé will be a Principal Investigator co-leading a research pillar in the Canadian Network of Networks to Reduce Cardiovascular Mortality and Morbidity in Pregnancy (CaNCaM-Preg), Nominated Principal Investigator Dr. Rohan D’Souza). This is one of two Research Networks of Excellence in Women’s Heart and/or Brain Health to have received a $5 million grant from Heart and Stroke, Brain Canada, and the Canadian Institutes of Health Research – Institute of Gender and Health.
About the study
Hypertensive Disorders and Cardiovascular Severe Maternal Morbidity in the US, 2015-2019 | Obstetrics and Gynecology by Isabelle Malhamé, Kara Nerenberg, Kelsey McLaughlin, Sonia M. Grandi, Stella S. Daskalopoulou, and Amy Metcalfe was published in JAMA Network Open on Oct 3, 2024.
doi:10.1001/jamanetworkopen.2024.36478