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The adverse cardiovascular risk factor profile of women with pre-eclampsia develops over time in the years before pregnancy

Retnakaran R, Shah BR. BJOG. 2021; 129(9):1512-20. Epub 2021 Dec 26. DOI:

Objective — Women with a history of pre-eclampsia have an elevated lifetime risk of cardiovascular disease that may be partly attributed to an adverse cardiovascular risk factor profile, the etiology of which is unclear. Hypothesizing that this adverse risk profile may begin to arise over time in the years before pregnancy, we sought to evaluate the pregravid changes over time in cardiovascular risk factors in women who go on to develop pre-eclampsia and those who do not.

Design, Setting, Population, and Methods — With population-based administrative databases, we identified all nulliparous women in Ontario, Canada, who had singleton pregnancies between Jan/2011 and Dec/2018 and ≥2 measurements of the following analytes between Jan/2008 and the start of pregnancy: A1c, glucose, lipids, and transaminases. The 156,278 women (of whom 3,827 developed preeclampsia) had mean 4.0±3.3 pregravid tests overall. The two most recent pregravid tests were performed at median 0.6 and 1.9 years before pregnancy, respectively.

Results — Women who developed pre-eclampsia had higher pregravid A1c, fasting glucose, random glucose, LDL-cholesterol, triglycerides, and ALT, and lower HDL-cholesterol, than their peers (all p<0.0001). In the years before pregnancy, women who went on to develop pre-eclampsia had higher annual increases than their peers in triglycerides (13.8-fold higher; p=0.0004) and random glucose (1.55-fold higher; p=0.001), coupled with a greater annual decrease in HDL-cholesterol (9.7-fold higher; p=0.002). During this time, fasting glucose increased in women who developed pre-eclampsia but decreased in their peers (p=0.01).

Conclusion — In women who develop pre-eclampsia, an adverse cardiovascular risk factor profile evolves over time in the years before pregnancy.