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Postpartum microvascular functional alterations following severe preeclampsia.

Preeclampsia is associated with adverse maternal health outcomes later in life. Vascular endothelial dysfunction has been previously described following preeclampsia. We hypothesized that microvascular endothelial dysfunction associated with preeclampsia persists postpartum and may identify those at greatest risk of future cardiovascular disease. The objective of this study was to examine postpartum microvascular endothelial function in women after a pregnancy complicated by preeclampsia. Women with previous preeclampsia (n=30) and normotensive controls (n=30) between 6 months and 5 years postpartum were recruited. Severity of preeclampsia (severe (n=16) and mild (n=14)) was determined by standardized chart review. Microvascular reactivity in the forearm was measured with laser speckle contrast imaging, coupled with iontophoresis; endothelium-dependent and -independent vasodilation was induced with 1% acetylcholine and sodium nitroprusside solutions, respectively. A post-occlusive reactive hyperemia test assessed vasodilatory response following three minutes of suprasystolic (200 mmHg) occlusion with a mechanized cuff. Women with prior severe preeclampsia exhibited significantly higher vasodilation to acetylcholine and sodium nitroprusside compared to controls (P<0.01; P=0.03) and prior mild preeclampsia (P=0.03; P<0.01). Neither the degree of post-occlusive reactive hyperemia (P=0.98), nor time to return halfway to baseline (OR=1.026 (0.612, 1.72); P=0.92), differed between preeclampsia and controls. In conclusion, severe preeclampsia is associated with heighticrovascular endothelium-dependent and -independent vasoreactivity. These changes, or a common antecedent, may be linked to postpartum alterations in vascular function that predispose women to disease after preeclampsia. Further investigation should identify the contributing mechanism and the degree to which it could be amenable to medical intervention.