We have extensively reviewed the article titled “Five-year risk of all-cause death and cardiovascular events in women with gestational diabetes and hypertensive disorders of pregnancy” authored by Bucci et al. We appreciate the authors’ diligent work on this critical subject, warranting acknowledgement from readers. Our perspective resonates with the articles conclusion that gestational diabetes and hypertension, especially pre-eclampsia, have a significant impact on long-term cerebrocardiovascular health, and it’s essential to highlight their management to improve women’s overall well-being. However, we believe that a few supplementary factors could have further strengthened the article’s conclusion. Firstly, it is crucial to emphasize that the study lacks an adequate analysis of reproductive history, overlooking important factors such as parity, multiple pregnancies, interpregnancy intervals and the use of assisted reproductive technology (ART). These factors can impact both gestational complications and long-term cardiovascular health, and their omission may obscure relationships between pregnancy history and cardiovascular risk. To improve this understanding, it is crucial to collect detailed reproductive history data and adjust for these factors in the analysis. ,
Additionally, the study neglects to consider the impact of lactation, which constitutes a significant gap in the analysis, considering the well-established benefits of breastfeeding in reducing maternal cardiovascular risk. To address this, the study should advocate the inclusion of detailed lactation tracking, including duration, intensity, and exclusivity of breastfeeding. Such a study design can more accurately assess lactation’s effect on long-term cardiovascular risk and address this gap.
Moreover, a critical concern arises regarding the definitions of early versus late-onset preeclampsia (PE) used in this study, as they were primarily based on gestational age at delivery. Recent evidence challenges this approach, proposing that PE subtypes should instead be classified based on the presence of fetal growth restriction (FGR) or a normally grown fetus. This shift in classification is crucial, as it acknowledges the distinct underlying pathophysiologies of PE, which gestational age alone may not capture adequately. Furthermore, the study fails to differentiate cases with recurrent episodes of PE, a key oversight considering recurrent PE is a known risk factor for the future development of hypertension and cardiovascular disease (CVD). By not accounting for this high-risk subgroup, the study potentially dilutes its findings, leading to imprecise conclusions about the relationship between gestational complications and long-term cardiovascular outcomes.
Lastly, the study exhibited limited analysis of cardiac function, especially given the links between pre-eclampsia and gestational diabetes mellitus with increased long-term cardiovascular risk. To capture early signs of heart remodeling ensuring a more comprehensive evaluation of long-term cardiovascular risk, cardiac function assessments, for example, ECG, Cardiopulmonary testing and magnetic resonance imaging should have been added for meaningful long-term health insights.
Acknowledging these limitations and gaps in the existing literature is essential for fostering a more insightful understanding.
Funding
None.
Declaration of competing interest
The authors declare that they have no conflict of interest.
Acknowledgments
None.
References
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