Endothelial dysfunction and vascular stiffness in women with a previous pregnancy complicated by early or late pre-eclampsia

OBJECTIVES: Pre-eclampsia leads to an increased cardiovascular risk later in life. The persistence of endothelial dysfunction after delivery may represent the link between pre-eclampsia and cardiovascular disease. We aimed at evaluating endothelial function and arterial stiffness after pregnancies complicated by early-onset or late-onset pre-eclampsia and their correlation with gestational age and mean uterine artery pulsatility index both considered at the diagnosis of pre-eclampsia and birth weight percentile. METHODS: 30 women who experienced early-onset pre-eclampsia, 30 with a previous late-onset pre-eclampsia and 30 controls were recalled from 6 months to 4 years after delivery. All women included were free from cardiovascular risk factors and drugs. We studied them by peripheral arterial tonometry and pulse wave analysis. RESULTS: All vascular parameters were all significantly impaired in early-onset pre-eclampsia. Late-onset pre-eclampsia showed higher vascular rigidity than controls' and normal values of reactive hyperaemia index, although it was significantly lower in respect with controls'. On the multivariate analysis gestational age and mean uterine artery pulsatility index, both considered at the diagnosis of the disease, and birth weight percentile were statistically related to the vascular indexes we studied, after correcting for confounding parameters. CONCLUSIONS: Women with previous pregnancies complicated by pre-eclampsia, in particular cases with early-onset of the disease, showed a persistent microcirculatory dysfunction, as suggested by a significant reduction of reactive hyperaemia index value, and an increased arterial stiffness.