Women with a history of pregnancy complications should receive screening

Pregnancy complications and maternal cardiovascular risk: opportunities for intervention and screening? BMJ Volume 325, pp 157-60

Recent evidence suggests that women with a history of complications in pregnancy may be at increased risk of diabetes and heart disease in later life. Researchers in this week’s BMJ suggest that these women should be screened and given relevant health education. Women who develop diabetes during pregnancy (a condition known as gestational diabetes) are at increased risk of diabetes and should be screened and given counselling and lifestyle advice, say the authors. Similarly, women with a history of pre-term delivery or women who have had a very low birthweight baby also seem to be at increased risk, and should be screened in their late 30s.

Screening and primary prevention strategies should also be offered to women with a history of pregnancy complications, such as pre-eclampsia.

To help ensure that appropriate women are screened, adverse pregnancy outcomes could be used in general practitioners’ computer databases for targeted health screening programmes, suggest the authors.

The potential for ’modifying’ risk factors before a subsequent pregnancy or in early pregnancy requires further investigation, add the authors. For example, studies have shown that increasing exercise during pregnancy may increase birth weight and reduce the risk of gestational diabetes.

“Such data would suggest that complications are not simply genetically determined, but that lifestyle factors play a major role. At present, this remains speculative, and further research is needed to examine this important question,” they conclude.

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