Patient cohort
In this study, a cohort of women diagnosed with PE who underwent
cardiovascular health screening at 6 months postpartum was assembled
from two study centres (Kingston and Ottawa, ON, Canada). In Kingston,
women who develop a pregnancy complication are referred to the Maternal
Health Clinic (Kingston General Hospital) for postpartum cardiovascular
health screening at 6 months postpartum as part of routine, standard of
care. Assessments and evaluations, including the calculation of a
lifetime cardiovascular risk score, conducted at the Maternal Health
Clinic have been previously described.28 From this
clinic, we recruited eligible study participants at the time of their
6-month postpartum visit (between 2011 and 2017). Women diagnosed with
PE who had placenta pathology performed at delivery of the index
pregnancy (PE diagnosis) were approached to participate in the study.
In Ottawa, women were recruited to participate in the study as part of
the DREAM Study research protocol designed to emulate the Maternal
Health Clinic. Women diagnosed with PE prior to delivery were recruited
from inpatient services at The Ottawa Hospital, General Campus between
2013 and 2018. Placentas from each participant were sent to Anatomical
Pathology at the Children’s Hospital of Eastern Ontario. Six months
after delivery, participants returned to the Ottawa Hospital for
cardiovascular health screening performed by the research study nurse.
The assessments performed at this study visit were identical to those
performed at the Maternal Health Clinic and a lifetime cardiovascular
risk score was calculated for each participate as described
previously.28 At both sites, all women provided
written informed consent to participate in the study.
PE was defined according to the contemporaneous Society of Obstetricians
and Gynaecologists of Canada criteria including hypertension (blood
pressure ≥140/90 mmHg, on at least two occasions >15mins
apart after 20 weeks’ gestation) with new proteinuria (≥0.3g/day by 24h
urine collection, ≥30mg/mmol by protein:creatinine ratio, or ≥1+ by
urinary dipstick), or one or more adverse conditions (e.g.,
headache/visual symptoms, chest pain/dyspnea, nausea or vomiting, right
upper quadrant pain, elevated WBC count) or one or more severe
complications (e.g., eclampsia, uncontrolled severe hypertension,
platelet count <50x109/L, acute kidney
injury).30 Women with chronic hypertension, known CVD
prior to pregnancy, known kidney disease prior to pregnancy, or diabetes
(type I, type II, gestational) were excluded. Small-for-gestational age
(SGA) status of the infant was determined if birthweight was
<5th percentile for gestational age and
sex.31 Clinical data including medical and family
history, pregnancy outcome and postpartum cardiovascular health results
were collected by chart review following 6 months postpartum
cardiovascular screening.