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Page 2 of 8 Vakhtangadze et al. Vessel Plus 2019;3:19 I http://dx.doi.org/10.20517/2574-1209.2019.07

cardiovascular morbidity remains high in the population, moreover cardiovascular morbidity is increased
[3]
in women at 35-54 years . Arterial hypertension is an important, powerful risk factor for cardiovascular
[4]
acute episodes, is characterized by genetic polymorphism ; association of arterial hypertension with
[5]
different metabolic disorders - metabolic syndrome, diabetes is particularly dangerous . Moreover, it was
found that haemorrhage and hypertensive disorders are major contributors to maternal deaths in developing
[2]
countries .
Preeclampsia/Eclampsia is a multiorgan syndrome associated with pregnancy, which occurs in 2%-8%
[6-9]
of pregnant women . The main characteristics of preeclampsia/eclampsia are pregnancy and elevation
of blood pressure. It is considered that the arterial hypertension in pregnancy is clearly associated with
cardiovascular morbidity during lifetime [1,6,7,10,11] .

Preeclampsia/Eclampsia develops in 3%-5% of pregnancies in developed countries and 7.5%-8% of all over
the world [9,12-14] . Preeclampsia/eclampsia is clearly linked to gestational age, offspring baby weight, nulliparity,
etc. The cohort research study in Denmark of 536419 female has shown that delivery at 32-36 weeks of
pregnancy increases the risk of next early premature labor from 2.7% to 14.7%, and the risk of preeclampsia
from 1.1% to 1.8%. This study also showed that the first childbirth up to 28 weeks of pregnancy increases the
risk of premature labour at next pregnancy by 26% and the risk of development of preeclampsia by 3.2%.
Preeclampsia during first pregnancy increases the risk of preeclampsia during next pregnancy from 14.1%
to 25.3%. Other studies also confirm that there are 3 times rise of cardiovascular morbidity and 7 times the
incidence of hypertension in this group of population [15,16] .

Excessive weight, hypertension before pregnancy, age, metabolic disorders before pregnancy increases
the risk of development of preeclampsia [6,17,18] . On the other hand, preeclampsia is clearly associated with
the development of metabolic disorders in life, so it is not surprising that women with preeclampsia and
eclampsia have a higher risk of cardiovascular morbidity.

DEFINITON OF HYPERTENSIVE DISORDERS DURING PREGNANCY
[19]
Hypertension in pregnancy comprises :
• Pre-existing hypertension: precedes pregnancy or develops before 20 weeks of gestation. It usually
persists for more than 42 days post-partum and may be associated with proteinuria.
• Gestational hypertension: develops after 20 weeks of gestation and usually resolves within 42 days post-
partum.
• Preeclampsia: gestational hypertension with significant proteinuria (> 0.3 g/24 h or Albumin/creatinine
ratio ≥ 30 mg/mmol). It occurs more frequently during the first pregnancy, in multiple pregnancy, in
hydatidiform mole, in antiphospholipid syndrome, or with pre-existing hypertension, renal disease,
or diabetes. It is often associated with foetal growth restriction due to placental insufficiency and is a
common cause of prematurity.
• Pre-existing hypertension plus superimposed gestational hypertension with proteinuria.
• Antenatally unclassifiable hypertension: this term is used when BP is first recorded after 20 weeks of
gestation and hypertension is diagnosed; re-assessment is necessary after 42 days post-partum.

Preeclampsia and eclampsia develops before, during and after delivery. It may be firstly developed in the
postpartum period, accompanied by manifestations of severe multiorgan impairment. Late postpartum
eclampsia can be manifested with severe brain, heart, pulmonary artery impairment in postpartum
[20]
period .
European Society of Cardiology considers arterial blood pressure 140-159/90-109 mmHg as mild and
160/110 mmHg as severely elevated for pregnant women, what is in agreement with other societies as well [6,19,20] .