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during pregnancy what affects response from endocrine glands. Thus, during pregnancy levels of estrogen,
[47]
progesterone, thyroid hormones, aldosterone, cortisol are rising , changes in insulin-resistance are
developing. Each of these factors participate in atherogenesis and impairment of metabolic profile.

All above mentioned are well-known factors associated with normal pregnancy and impairment in one of
them may have influence on others as well.

Preeclampsia (Eclampsia) is condition related to ischemia of placenta. There are studies that confirm the
link between preeclampsia and gestational arterial hypertension with endocrine and metabolic diseases-
preeclampsia is considered as a risk-factor of hypothyroidism, diabetes mellitus, and dyslipidaemia [48-50] .
Each of them independently increases the incidence of cardiovascular morbidity.

Healthy pregnancy is driven into a growing of pro-atherogenic metabolic state [51,52] . Shortly after conception
[53]
[54]
pregnant women develops a high cardiac output , hypercoagulability , and increased inflammatory
[57]
[55]
activity . After 20 weeks there is insulin resistance [52,56] and hyperlipidaemia . Healthy women responds
adequately and tolerates well physiologic changes during pregnancy, but woman with inherited or
acquired predisposition to different chronic diseases may not tolerate pregnancy induced hormonal or
[57]
hemodynamic changes . These gestational changes are usually more pronounced in women who later
develop preeclampsia. The effect of coexisting risk-factors are clearly confirmed in several studies. This is
partly due to pre-existing, subclinical inflammatory and/or cardiovascular risk factors in “healthy” women
[58]
who go on to develop preeclampsia . These women are more likely to be overweight [59,60] have higher lipid
levels, higher blood pressure, insulin resistance and are more likely to have a thrombophilia, compared with
women who go on to have a normotensive pregnancy.

Angiogenic factors also contribute to development of preeclampsia. Seems that maternal diseases (or
predisposition) is related to anti-angiogenic factors sFlt-1 and sEng, released by an affected placenta. Are
these anti-angiogenic proteins involved in development of the maternal diseases later is not clear, however
[22]
could indicate the predisposition of development of cardiovascular abnormalities .

Preeclampsia is associated with impairment of vascular function, impaired endothelial function, share some
common features of development of atherosclerosis. The 498 women from the Epidemiology of Coronary
Artery Calcification Study were evaluated for presence of subclinical coronary atherosclerosis using logistic
regression model, up to 10.4% had history of hypertension during pregnancy, what also was associated with
impairment of kidney function and coronary artery calcium score later during lifespan [22,61] .

Insulin resistance is developing physiologically in healthy pregnant women, however may remain after
delivery and even progress in certain women with predisposition (because of acquired or inherited factors).
In a population-based, retrospective cohort study for 1,010,068 pregnant women was determined two-
fold rise of risk of development of diabetes during up to 16.5 years after pregnancy, even in the absence of
gestational diabetes. The presence of preeclampsia or gestational hypertension in women with gestational
diabetes also significantly rises the lifelong risk of diabetes compared to gestational diabetes without
preeclampsia or gestational diabetes [21,62] which is independent risk for future cardiovascular events.

Vascular wall seems that is responding to preeclampsia. Thus study preformed showed that Carotid Artery
Intima-media thickening us reliably higher in women with preeclampsia, is reducing after delivery, but
[63]
remain significantly higher in a year after delivery in women with previous preeclampsia .

CONCLUSION
Cardiovascular morbidity is multifactorial, preclinical stage is starting in early ages, is linked to multiple
risk-factors. Cardiovascular morbidity has several unique characteristics for women; pregnancy, gestational