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Association of placental pathology and postpartum cardiovascular risk screening following preeclampsia: an observational cohort study
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  • Samantha Benton,
  • Erika Mery,
  • David Grynspan ,
  • Laura Gaudet,
  • Graeme Smith,
  • Shannon Bainbridge
Samantha Benton
Queen's University
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Erika Mery
University of Ottawa Faculty of Health Sciences
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David Grynspan
The University of British Columbia Faculty of Medicine
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Laura Gaudet
Queen's University
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Graeme Smith
Queen's University
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Shannon Bainbridge
University of Ottawa
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Abstract

Objective: To determine the association between placental lesions and lifetime cardiovascular disease (CVD) risk screening at 6 months postpartum following preeclampsia (PE). Design: Observational cohort study. Setting: Tertiary care centres in Ottawa and Kingston, Ontario, Canada. Population: Women diagnosed with PE who received cardiovascular screening at 6 months postpartum. Methods: Placentas from women diagnosed with PE were evaluated for histopathological lesions according to a standardised synoptic data collection form with blinding to clinical outcomes apart from gestational age at delivery. At 6 months postpartum, each participant was screened for cardiovascular risk factors and a lifetime cardiovascular risk score was calculated. A risk score >35% was deemed high risk for lifetime CVD. Main Outcome Measures: The association between placental lesions and lifetime CVD risk was assessed using odds ratios (OR, 95% confidence intervals). Results: Of the 85 participants, 53 (62.4%) screened high-risk for lifetime CVD. High-risk women had more severe lesions of maternal vascular malperfusion (MVM). MVM lesions with a severity score >2 resulted in a 3-fold increased risk of screening high risk for lifetime CVD (OR 3.10 [1.20-7.92]). MVM lesion score >2 was moderately predictive of high-risk screening (AUC 0.63 [0.51,0.75]; sensitivity: 71.8% [54.6,84.4]; specificity: 54.7% [41.5,67.3]). When clinical data was added, the model’s predictive performance improved (AUC 0.73 [0.62,0.84] sensitivity 78.4% [65.4,87.5]; specificity 51.6% [34.8,68.0]). Conclusions: PE women with MVM are more likely to screen high-risk for lifetime CVD compared to women without these lesions. Placenta pathology may provide a unique modality to identify women for postpartum cardiovascular screening.

Peer review status:UNDER REVIEW

28 Jul 2021Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
29 Jul 2021Assigned to Editor
29 Jul 2021Submission Checks Completed
23 Aug 2021Reviewer(s) Assigned