Placental Pathology and Long-Term Cardiometabolic Sequelae in Women with a History of Preeclampsia in South West Nigeria: A Cohort with Mechanistic Investigation

Preeclampsia is increasingly recognised as a cardiovascular disease risk equivalent, with placentally mediated vascular programming implicated in long-term cardiometabolic risk, yet the mechanistic pathways connecting placental pathology to postpartum cardiovascular risk have not been investigated in Nigerian women. This dissertation examines placental pathology characteristics and their relationship to long-term cardiometabolic outcomes in a cohort of women with prior preeclampsia in Ogun, Oyo, and Lagos States, South West Nigeria. A prospective follow-up cohort of 150 women with preeclampsia (index delivery 2018 to 2021) and 150 matched normotensive controls underwent placental pathology review of banked placental specimens and follow-up cardiovascular assessment at three to five years postpartum, including blood pressure, echocardiography, fasting lipid and glucose profile, and inflammatory biomarkers. Preeclamptic placentas showed significantly higher rates of accelerated villous maturation (68 percent vs 22 percent), decidual vasculopathy (62 percent vs 14 percent), and perivillous fibrin deposition (54 percent vs 18 percent). At follow-up, preeclamptic women had significantly higher rates of chronic hypertension (34 vs 8 percent), insulin resistance (28 vs 11 percent), and left ventricular hypertrophy (19 vs 5 percent). Decidual vasculopathy severity correlated with systolic blood pressure at follow-up. The dissertation introduces the Placental Vascular Programming Hypothesis for Nigerian women and advocates postpartum cardiovascular surveillance protocols for preeclampsia survivors. Keywords: preeclampsia, placental pathology, cardiometabolic risk, South West Nigeria, postpartum surveillance