From pregnancy to menopause: impact of reproductive history on women health at midlife

Background: Obstetric history complicated by hypertensive disease, gestational diabetes, preterm delivery and low birth weight proved to be relevant to increased cardiovascular risk later in life. Menopausal transition is a moment in which the pathology might become manifest, but also a time to set preventive strategies in terms of cardio-metabolic prevention; obstetric history has to be taken into account in this perspective. Aim: In this observational study we assessed medical and obstetric history of 95 midlife women visiting Menopause Clinic at our Hospital (IRCCS Policlinico S. Matteo, Pavia) for treating symptoms. Results: Mean age was 54±4.8 years. The majority of women were postmenopausal (70.6%) and had a spontaneous menopause (72%). In 19 cases (20%) emerged a history of pregnancy complication (hypertensive disease, gestational diabetes, preterm delivery, birth weight < 2500 g or >4000 g). Hypertension was reported by 22 women (23,15%), with 7 of them (31.8%) having complicated obstetric history; notably, 3 out of 5 women with a history of hypertensive disease of pregnancy developed chronic hypertension later in life, with the remaining two patients having systemic pathologies requiring continuous followup(respectively polycystic kidney disease and antiphospholipid syndrome). Only two women in our cohort had type 2 diabetes mellitus, one of them reported neonatal birth weight > 4000 g; overall 5 women reported their neonates weighted more than 4000 g at birth, 3 of them having a BMI > 30 kg/cm2. Only one patient received a diagnosis of gestational diabetes and did not report adverse outcome later in life. Interestingly, 5 out 7 women with a history of preterm delivery resulted to have an autoimmune condition. Conclusions: Results of this study are in line with the evidences that obstetric history has an impact on woman health later in life. It seems like menopause consultation is a golden moment to outline the importance of obstetric history for future health, even though related conditions might become manifested at this time. Therefore, preventive strategies need to be planned early in postpartum, with periodic follow-up visits in order to modulate modifiable risk factors for a healthier person at the time of menopause. A limit of our study sample was that obstetric history is self-reported by the patient and that preventive strategies during pregnancy may have changed significantly through the years, both factors contributing to possible missed cases.