Pré-eclâmpsia e riscos latentes após o parto (Estudo Perla - Brasil): Avaliação de marcadores de disfunção endotelial.

Abstract

Preeclampsia (PE) is a pregnancy-specific disorder affecting approximately 2 to 10% of pregnancies worldwide, emerging as a risk factor for the development of cardiovascular diseases (CVD). To date, definitive guidelines for postpartum monitoring and prevention of subsequent CVD in women affected by PE have not been established. Endothelial dysfunction plays a crucial role in the pathophysiology of PE, with substantial evidence indicating that these changes do not resolve after childbirth. Asymmetric Dimethylarginine (ADMA) and thrombomodulin (TM) are biomarkers reflecting nitric oxide bioavailability and endothelial injury, respectively, with elevated levels previously associated with atherosclerosis, chronic kidney disease, and acute myocardial infarction. Given the potential alterations in these markers before the manifestation of clinical symptoms, endothelial dysfunction can be considered the intersection between the history of PE and the increased risk of CVD. In this context, the aim was to assess physical parameters (BMI, body fat percentage, blood pressure, waist and hip circumferences), lipid profile, metabolic syndrome, and the biomarkers ADMA and TM in women with a history of PE, comparing them to those with healthy pregnancies during the same period. A total of 188 women were evaluated six to 15 years post-pregnancy: 102 with healthy pregnancies and 86 with a history of PE. A significant increase was observed in BMI values (p=0.004), body fat percentage (p=0.008), waist circumference (p=0.007), systolic blood pressure (p<0.001), diastolic blood pressure (p<0.001), mean arterial pressure (p<0.001), LDL (p<0.001), and prevalence of metabolic syndrome (p=0.027) in women with a history of PE. Additionally, elevated plasma levels of ADMA and TM were detected in women with a history of PE (p=0.012 and p=0.002, respectively). These findings suggest an association between endothelial dysfunction and an increased future risk of CVD in women with a history of PE. Understanding the mechanisms through which PE affects the cardiovascular system contributes to identifying women at risk for developing a subclinical tool that will guide decision-making in the management of these women after PE.