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Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Associate Professor Peter Eriksson, University of Gothenburg, Sweden
- Second opponent: Associate Professor Bjørnar Grenne, NTNU - Norwegian University of Science and Technology, Trondheim
- Third member and chair of the evaluation committee: Associate Professor Meryam Sugulle, University of Oslo
Chair of the Defence
Professor II Harriet Akre, University of Oslo
Principal Supervisor
MD, PhD Mette-Elise Estensen, Oslo University Hospital
Summary
Preeclampsia affects up to 7% of all pregnancies and is associated with an increased risk of cardiovascular disease later in life. There is a lack of knowledge about cardiac function and cardiorespiratory fitness on long-term follow-up in patients after preeclampsia with severe features.
Patients previously corrected for the congenital heart defect coarctation of the aorta, a narrowing of the main artery, are at risk of developing preeclampsia. Knowledge of pregnancy outcomes in women with coarctation of the aorta is essential for assessment before pregnancy, and to educate and inform patients and caregivers in a satisfactory manner.
In the doctoral thesis “Cardiovascular function and cardiorespiratory fitness in women with previous preeclampsia” Lasse Gronningsaeter and co-authors measured blood pressure, cardiac function, and cardiorespiratory fitness in women with previous preeclampsia compared to healthy women in the control group. Cardiac function was measured by ultrasound, and cardiorespiratory fitness was measured by a comprehensive cardiopulmonary exercise test on a treadmill. Physical activity was measured by the use of accelerometers. Cardiac function, expressed in the left ventricular functional parameters’ ejection fraction and global longitudinal strain, was significantly reduced in women with previous preeclampsia seven years after pregnancy compared to healthy women in the control group. One-third of the women had hypertension at long-term follow-up after preeclampsia. Cardiorespiratory fitness, measured as oxygen uptake at peak exercise on the treadmill test, was also significantly lower in women with previous preeclampsia, as was their physical activity level.
Half of the patients with poor cardiorespiratory fitness had one or more cardiac limitations to exercise. The other half were unfit with no cardiopulmonary limitations. The strongest predictors for the reduction in oxygen uptake at peak exercise were body mass index and physical activity level. Preeclampsia and lower physical activity levels increased the likelihood of having poor cardiorespiratory fitness.
In the register study, using clinical data from the National Unit for Pregnancy and Heart Disease database, Gronningsaeter and co-authors found a high prevalence of preeclampsia in pregnancies in women with coarctation of the aorta, with higher age at first pregnancy and higher body mass index being significant predictors of preeclampsia.
The findings of hypertension, early signs of cardiac impairment, poor cardiorespiratory fitness, and low physical activity in women with previous preeclampsia are essential knowledge for caregivers to inform women after preeclamptic pregnancies. Also, the finding of a high prevalence of preeclampsia in women with coarctation of the aorta is necessary to inform the caregivers and give these patients proper counselling before pregnancy. The results highlight the need for close clinical follow-up and advice on lifestyle interventions targeted toward women after preeclampsia to prevent the development of cardiovascular disease.
Additional information
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