Microvascular dysfunction in women with a history of hypertensive disorders of pregnancy: A population-based retrospective cohort study

Abstract

Objective: To evaluate microvascular function in women with previous hypertensive disorders of pregnancy (HDP).

Design: Retrospective population-based cohort study.

Setting: Linköping, Sweden.

Population: Women aged 50-65 years, participating in the Swedish CArdioPulmonary bioImage Study (SCAPIS) at one site (Linköping) 2016-18, who underwent microcirculatory assessment (N = 1222).

Methods: Forearm skin comprehensive microcirculatory assessment was performed with a PeriFlux PF6000 EPOS (Enhanced Perfusion and Oxygen Saturation) system measuring oxygen saturation and total speed resolved perfusion. Obstetric records were reviewed to identify women with previous HDP. Data on cardiovascular risk factors, comorbidities, medication, lifestyle, anthropometric data, and biochemical analyses were obtained from SCAPIS. The microcirculatory data were compared between women with and without previous HDP.

Main outcome measures: Skin microcirculatory oxygen saturation and total speed resolved perfusion at baseline and post-ischaemic peak.

Results: Women with previous pre-eclampsia displayed impaired post-ischaemic peak oxygen saturation compared with women with normotensive pregnancies (88%, interquartile range [IQR] 84-89% vs 91%, IQR 87-94%, p = 0.001) 6-30 years after pregnancy. The difference remained after multivariable adjustment (β -2.69, 95% CI -4.93 to -0.45).

Conclusions: The findings reveal microvascular dysfunction at long-term follow up in women with previous pre-eclampsia and strengthen the possible role of endothelial dysfunction as a link to the increased risk of cardiovascular disease in women with HDP.

Keywords: cardiovascular disease; endothelial dysfunction; hypertension pregnancy-induced; microcirculation; pre-eclampsia; pregnancy.