Serum AMH Levels in Women With a History of Preeclampsia Suggest a Role for Vascular Factors in Ovarian Aging

Context: The association between early menopause and vascular disease as a possible causative factor has recently received attention. Preeclampsia (PE) is associated with future cardiovascular risk factors, and this premature vascular aging potentially modifies the ovarian aging process. Objective: The purpose of this study was to assess whether women with a history of PE have lower anti-Mullerian hormone (AMH) levels than women with normotensive pregnancies. Design: This was a retrospective cohort study. Setting: The study was conducted in a tertiary referral center. Patients: Clinical data and blood samples of participants in the Preeclampsia Risk EValuation in FEMales study were used (336 women with a history of PE and 329 women after a normotensive pregnancy). Interventions: There were no interventions. Main Outcome Measures: The relative decrease in AMH levels was assessed after a median follow- up of 10.5 years. Results: The mean AMH level was 2.00 +/- 1.87 mu g/L in the PE group compared with 2.26 +/- 2.56 mu g/L in the reference group. Linear regression analysis with censoring for undetectable AMH levels, adjusted for age, smoking, and hormonal contraceptive use, showed a relative reduction in AMH levels of 20.9% at any age (fold change 0.79, 95% confidence interval, 0.67-0.94). Conclusions: We demonstrate that women with a history of PE have significantly lower AMH levels than women with normotensive pregnancies. Calculations based on a reference population indicate advancement of reproductive age of approximately 1.5 years. Because PE is considered a manifestation of impaired vascular health, these results support the hypothesis that compromised vascular health could act as a causative mechanism in early ovarian aging.