Vascular dysfunction in women with recurrent pregnancy loss

Abstract

Pregnancy provides an opportunity to reveal various cardiovascular disease risk factors and estimate a woman's lifetime risk because of its unique cardiovascular and metabolic stress. Pulsed Doppler ultrasonography in the uterine artery may be useful in distinguishing women with recurrent pregnancy loss (RPL) caused by vascular dysfunction from women with unexplained RPL. Furthermore, the plasma level of adrenomedullin, which is often associated with pathological processes of the vasculature, is elevated in women with RPL. In the light of these studies, vascular dysfunction may be the key to the pathophysiology of pregnancy loss.

History of pregnancy loss is known to be associated with a higher risk of myocardial infarction, and the risk increased significantly with the number of pregnancy loss. Reproductive history of obstetrical complications associated with RPL such as preeclampsia, premature delivery, fetal growth restriction, and placental abruption could be considered a“failed stress test,” possibly unmasking early or preexisting vascular dysfunction and vascular or metabolic disease. Therefore, these women should be carefully monitored and controlled. Healthcare professionals should take a careful and detailed history of RPL and characteristic pregnancy complications.

It is unlikely to treat all young women with low dose aspirin following the occurrence of PRL without any other risk factors. Pharmacological therapies for hypertension, insulin resistance, or dyslipidemia are also available but should be tailored on an individual basis.