Severe morning sickness has long-term effects

4 minute read

Women with hyperemesis gravidarum have a higher risk of cardiovascular disease, research suggests.

Severe morning sickness puts women at higher risk of significant cardiovascular events in the three decades after having a baby, according to a Canadian study.

The study of 1.4 million women found that those with both pre-eclampsia and hyperemesis gravidarum had the highest risk of developing cardiovascular disease over the 32-year study.

But the Quebec women who only had hyperemesis gravidarum had a 46% higher risk of cardiovascular disease than those without either condition.

Women who had both pre-eclampsia and hyperemesis gravidarum had more than three times the risk of heart failure and valve disease in the following 30 years, and four times the risk of cardiomyopathy.

“Women with hyperemesis gravidarum who developed pre-eclampsia were particularly at risk of cardiovascular hospitalisation over the long term,” the researchers wrote in the Journal of the American Heart Association.

“The findings suggest that hyperemesis gravidarum may be a novel risk factor for cardiovascular disease of nonischaemic origin, regardless of pre-eclampsia.

“Women with hyperemesis gravidarum, especially hyperemesis combined with preeclampsia, may benefit from closer monitoring in the years following pregnancy to prevent adverse cardiovascular events.”

Of the study cohort, 5% developed pre-eclampsia and 1.2% had hyperemesis gravidarum. Among the women with hyperemesis gravidarum, 6.3% also developed pre-eclampsia. 

Any hyperemesis gravidarum was associated with cardiomyopathy (49% increased risk), heart failure (56%), inflammatory heart disease (71%), valve disease (78%), pulmonary embolism (57%), hypertension (53%) and conduction disorder (40%).

Commenting on the study, Melbourne cardiologist Associate Professor Monique Watts said this was the first study to show a link between hyperemesis gravidarum and cardiovascular disease.

“Women who experience complications during their pregnancy are at greater risk of cardiovascular disease in the future and often at an earlier age,” Professor Watts, lead cardiologist at the Women’s Heart Clinic at The Alfred, told TMR

“While this link has been firmly established in pre-eclampsia and gestational diabetes, the association with hyperemesis gravidarum has not previously been clearly established.

“Perhaps we have another screening tool to use to determine a young woman’s risk of developing heart disease so that modifiable risk factors such as blood pressure, cholesterol, diet and exercise levels can be more aggressively managed at an earlier age to minimise overall risk.” 

Professor Watts said pregnancy was increasingly being appreciated as a stress test for the cardiovascular system.

But opportunities for preventative health were too often missed, she said.

“Markers of elevated risk are incredibly useful and have an important place in practice.”

Professor Watts said the causal relationship between hyperemesis gravidarum and cardiovascular disease was unknown. “It’s difficult because we don’t fully understand the mechanism of hyperemesis gravidarum.”

Autoimmune disease is a well-established risk factor for cardiovascular disease, and some large population-based studies have found links between hyperemesis and autoimmune diseases such as rheumatoid arthritis, she said. 

“Hyperemesis gravidarum as also been linked with placental dysfunction disorders, which have also been linked with CVD. Disorders of placentation are thought to involve endothelial dysfunction which is implicated in cardiovascular disease.

Professor Watts said there could also be a genetic basis for the link.

“There is interest in the GDF15 gene which codes for a protein related to hyperemesis gravidarum. That same gene is involved in cardiovascular dysfunction, particularly heart failure, atrial fibrillation and coronary artery disease.” 

Over the three decades, the cumulative incidence of cardiovascular events in women with both conditions was 31 per 100 women. For those with only pre-eclampsia it dropped to 28, for those with only hyperemesis gravidarum it was 17 and for those with neither it was 14 per 100 women.

The researchers found that women with both hyperemesis and pre-eclampsia were more likely to have underlying comorbidity, multiple birth, and fetal congenital anomalies compared with women who had neither condition.

“Women with hyperemesis gravidarum were more likely to be socioeconomically disadvantaged, regardless of the presence of pre-eclampsia.”

Journal of the American Heart Association 2023, online 1 June

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