Pregnancy-related hypertension has already been proven to lead to a number of negative health outcomes later in life, including more bothersome menopause symptoms like hot flashes, the risk of dementia, kidney problems, and stroke. A new study suggests it can also lead to cardiovascular disease during menopause. Results of the study were presented at the 2024 Annual Meeting of The Menopause Society in Chicago, USA.

In the new study involving nearly 400 women with a mean age of 81.6 years, researchers sought to assess the association between a self-reported history of preeclampsia or eclampsia, gestational hypertension, and gestational diabetes with cardiovascular outcomes in postmenopausal women.

What they found is that a self-reported history of gestational hypertension was associated with cardiovascular disease. Women with preeclampsia or all three adverse pregnancy outcomes also had a numerically higher prevalence of heart disease, but it did not meet the standards of statistical significance. No association was found between gestational diabetes and heart disease.

“Future research based on a larger sample size is needed to better understand the role adverse pregnancy outcomes may have in cardiovascular disease development and risk stratification,” says Marie Tan, lead author from Drexel University College of Medicine in Philadelphia.

More detailed results will be discussed at the 2024 Annual Meeting of The Menopause Society as part of the presentation entitled “The association between adverse pregnancy outcomes and cardiovascular disease in menopausal women: results from a cross-sectional analysis.”

“Cardiovascular disease is the number one cause of mortality in women and it’s important to study any new risk factors” says Dr. Stephanie Faubion, medical director for The Menopause Society. “Although future research is still needed, studies like this are important and remind us to thoroughly discuss a patient’s health history, including any complications or adverse outcomes during pregnancy.”

Babies born to pregnant women with obesity are more likely to develop heart problems and diabetes as adults due to fetal damage caused by the high-fat, high-energy diet of their mother.

That’s the groundbreaking finding from a new study published in the Journal of Physiology that shows for the first time that maternal obesity alters a critical thyroid hormone in the fetal heart, disrupting its development.

Consuming a high-fat, sugary diet during pregnancy also increases the likelihood of the unborn baby becoming insulin resistant in adulthood, potentially triggering diabetes and causing cardiovascular disease. This is despite babies being a normal weight at birth.

University of South Australia researchers identified the link by analysing tissue samples from the fetuses of pregnant baboons fed a high-fat, high-energy diet in a biomedical research institute in the United States. They then compared this to fetuses from baboons on a control diet.

Lead author, University of South Australia PhD candidate Melanie Bertossa, says the findings are significant because they demonstrate a clear link between an unhealthy diet high in saturated fats and sugar, and poor cardiovascular health.

“There has been a long-standing debate as to whether high-fat diets induce a hyper- or hypothyroid state in the fetal heart. Our evidence points to the latter,” Bertossa says.

“We found that a maternal high-fat, high-energy diet reduced concentrations of the active thyroid hormone T3, which acts like a switch around late gestation, telling the fetal heart to start preparing for life after birth. Without this signal, the fetal heart develops differently.”

Bertossa says that diets high in fat and sugar can alter the molecular pathways involved in insulin signalling and critical proteins involved in glucose uptake in the fetal heart. This increases the risk of cardiac insulin resistance, often leading to diabetes in adulthood.

“You’re born with all the heart cells you will ever have. The heart doesn’t make enough new heart muscle cells after birth to repair any damage, so changes that negatively impact these cells before birth could persist for a lifetime.

“These permanent changes could cause a further decline in heart health once children reach adolescence and adulthood when the heart starts to age.”

Senior author, UniSA Professor of Physiology Janna Morrison, says the study demonstrates the importance of good maternal nutrition in the leadup to pregnancy, not only for the mother’s sake but also for the health of the baby.

“Poor cardiac outcomes were seen in babies that had a normal birth weight – a sign that should guide future clinical practice,” Prof Morrison says.

“Cardiometabolic health screening should be performed on all babies born from these types of pregnancies, not just those born too small or too large, with the goal being to detect heart disease risks earlier.”

Prof Morrison says that if rising rates of high-fat sugary diets are not addressed, more people will develop health complications such as diabetes and cardiovascular disease, which could result in shorter life spans in the decades ahead.

“Hopefully, with the knowledge we have now about the negative health impacts of obesity, there is potential to change this trajectory.”

The researchers are currently undertaking long-term studies of babies born to women on high- fat high-energy diets to track their health over decades.

“Maternal high-fat high-energy diet alters metabolic factors in the non-human primate fetal heart” is published in the Journal of Physiology and authored by researchers from the University of South Australia, University of Wyoming and Texas Biomedical Health Institute.

A new study from King’s College London shows that off-label prescriptions of a common antidepressant doesn’t help breathlessness in patients with respiratory disease – and may cause side effects.

Researchers warn prescribing medicines for a use which it has not been licensed could make things worse, even though the prescriber was trying to help.

The findings, presented at the ERS Congress in Vienna and published today in The Lancet Respiratory Medicine, show the desperate need for options to treat the symptoms of severe breathlessness, as there are no drugs licensed for this in the UK or most countries.

The severe breathlessness caused by chronic respiratory diseases greatly impacts patient’s quality of life. As well as creating substantial clinical challenges and health care costs. Most patients with diseases like this have few options to help with their symptoms.

Ahead of the trial, researchers surveyed doctors in respiratory and palliative medicine and found doctors were often using off-label prescribing – where a clinician prescribes a medicine for use in a different way than that stated in its licence. Various off-label prescriptions were being used, including common anti-anxiety and anti-depressant drugs like benzodiazepines and SSRIs.

Mirtazapine, a common antidepressant, was one of the types of drugs being prescribed. Case series and early studies showed it had potential. However, in this international trial, the first large-scale study to be done, researchers found that mirtazapine does not improve breathlessness in patients with respiratory disease compared with placebo. They also found that patients receiving mirtazapine had slightly more side effects and needed more care from hospitals and family members.

Chronic respiratory diseases affect 454.6 million people worldwide, with numbers predicted to increase with an aging population. Over 217 million people globally have Chronic Obstructive Pulmonary Disease (COPD) or Interstitial Lung Disease (ILD), both of which can cause severe breathlessness as they progress.

Off-label use can be as safe as on-label use if based on good evidence. It is often used when symptoms can’t be controlled with licenced medicines, particularly in serious illnesses. This is common in severe breathlessness care, making proper evaluation of medicines vital. Off-label prescribing doesn’t mean a doctor is making a mistake; it often happens when there are no other options to manage symptoms like breathlessness.

First author Professor Irene Higginson, King’s College London said: “Breathlessness is a widespread issue in palliative care as a symptom of respiratory diseases, heart disease and some cancers. When severe, it’s distressing for patients, as well as their caregivers, family and friends.  It diminishes people’s quality of life and often leads to considerable health and social care use, including driving emergency hospital admissions.

“Despite being a widespread issue we still don’t have effective treatments available. As such, many doctors turn to off-label prescribing, trying to help their patients.

“Our earlier survey found that 19% of respiratory and 11% of palliative physicians frequently recommend antidepressants for severe breathlessness in COPD, so these medicines are already being used off-label. This new trial concludes that mirtazapine is not recommended for the treatment of breathlessness, that the use of unlicensed medicines should be approached with caution and that it’s crucial to subject medicines in palliative care to rigorous trials.

“We need further research into potential therapies for severe breathlessness. In the meantime, we recommend clinicians use early identification and non-pharmacological approaches, such as those offered from breathlessness support services, to treat the symptom.”

The paper is published in The Lancet Respiratory Medicine.