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Hypertensive disorders of pregnancy and subsequent maternal cardiovascular health.

ABSTRACT: To examine associations between hypertensive pregnancy disorders and maternal cardiovascular disease (CVD) in later life. We examined the associations between blood pressure (BP) in pregnancy, gestational hypertension (GH) and preeclampsia (PE) with cardiovascular measurements 6 years after index pregnancy among 4912 women participating in the Generation R Study, the Netherlands. BP, left ventricular mass (LV mass), aortic root diameter (AOD), left atrial diameter, fractional shortening, and carotid-femoral pulse wave velocity (PWV). Early pregnancy systolic and diastolic BP were associated with more adverse maternal cardiovascular measurements and a higher incidence of chronic hypertension 6 years after pregnancy. GH was associated with a higher BP, a higher PWV, a larger AOD and an increased LV mass 6 years after index pregnancy. Compared to previous normotensive pregnancies these women had a sixfold increased risk to develop chronic hypertension after pregnancy (OR 6.6, 95% CI 4.6-9.5). Compared to women with a normotensive pregnancy, women with PE had a higher BP and a higher risk of chronic hypertension (OR 4.5, 95% CI 2.6-7.8) at follow-up. After adjustment for BMI at follow-up in all the analyses on GH, PE and cardiovascular measurements, effect estimates attenuated up to 65%, but remained significant. Both GH and PE are associated with markers of adverse maternal cardiovascular health after pregnancy with an increased risk of chronic hypertension. Women with GH and PE may be offered long-term cardiovascular follow-up incorporated in CVD risk management guidelines.

SUBMITTER: Bergen NE

PROVIDER: S-EPMC6061134 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Hypertensive disorders of pregnancy and subsequent maternal cardiovascular health.

Bergen Nienke E NE Schalekamp-Timmermans Sarah S Roos-Hesselink Jolien J Roeters van Lennep Jeanine E JE Jaddoe Vincent V W VVW Steegers Eric A P EAP

European journal of epidemiology 20180519 8

To examine associations between hypertensive pregnancy disorders and maternal cardiovascular disease (CVD) in later life. We examined the associations between blood pressure (BP) in pregnancy, gestational hypertension (GH) and preeclampsia (PE) with cardiovascular measurements 6 years after index pregnancy among 4912 women participating in the Generation R Study, the Netherlands. BP, left ventricular mass (LV mass), aortic root diameter (AOD), left atrial diameter, fractional shortening, and car ...[more]

PMID: 29779204

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Project description:BackgroundWomen with a history of hypertensive disorders of pregnancy (HDP) are nearly twice as likely to develop cardiovascular disease (CVD) as those who are normotensive during pregnancy. However, the emergence of CVD risk factors after HDP is less well-understood.ObjectiveTo identify associations between HDP and maternal CVD risk factors and chart the trajectory of risk factor development after pregnancy.DesignObservational cohort study.SettingUnited States.Participants58 671 parous NHS II (Nurses' Health Study II) participants who did not have CVD or risk factors of interest at baseline.MeasurementsWomen were followed for self-reported physician diagnosis of chronic hypertension and hypercholesterolemia and confirmed type 2 diabetes mellitus (T2DM) from their first birth through 2013; mean follow-up ranged from 25 to 32 years across these end points. Multivariable Cox proportional hazards models estimated hazard ratios (HRs) and 95% CIs, with adjustment for prepregnancy confounders.ResultsCompared with women who were normotensive during pregnancy, those with gestational hypertension (2.9%) or preeclampsia (6.3%) in their first pregnancy had increased rates of chronic hypertension (HRs, 2.8 [95% CI, 2.6 to 3.0] and 2.2 [CI, 2.1 to 2.3], respectively), T2DM (HRs, 1.7 [CI, 1.4 to 1.9] and 1.8 [CI, 1.6 to 1.9], respectively), and hypercholesterolemia (HRs, 1.4 [CI, 1.3 to 1.5] and 1.3 [CI, 1.3 to 1.4], respectively). Although these women were more likely to develop CVD risk factors throughout follow-up, the relative risk for chronic hypertension was strongest within 5 years after their first birth. Recurrence of HDP further elevated risks for all end points.LimitationParticipants self-reported HDP.ConclusionWomen with HDP in their first pregnancy had increased rates of chronic hypertension, T2DM, and hypercholesterolemia that persisted for several decades. These women may benefit from lifestyle intervention and early screening to reduce lifetime risk for CVD.Primary funding sourceNational Institutes of Health.

Project description:OBJECTIVE:To estimate whether weight gain between deliveries is associated with an increased risk of hypertensive disorders in a subsequent pregnancy. METHODS:This is a case-control study of women who had two live singleton births of at least 24 weeks of gestation at a single maternity hospital from January 1, 2005, to December 31, 2015, with no hypertensive disorder documented in the index pregnancy. Maternal weight gain between deliveries was measured as the change in body mass index (BMI) at delivery. Women who were diagnosed with any hypertensive disorder in the subsequent pregnancy were compared with those who experienced no hypertensive disorder in the subsequent pregnancy using ? statistics for categorical variables and t tests for continuous variables. Logistic regression was used to determine whether weight gain remained independently associated with hypertensive disorders after adjusting for potential confounders. RESULTS:Of 1,033 women, 188 (18.2%) were diagnosed with a hypertensive disorder in the subsequent pregnancy. Of these, 166 (88.3%) had a hypertensive disorder specific to pregnancy (gestational hypertension; preeclampsia; superimposed preeclampsia; or hemolysis, elevated liver enzymes, and low platelet count syndrome), and 22 (11.7%) had chronic hypertension only. Greater weight gain between deliveries was significantly associated with a higher frequency of hypertensive disorders, which remained significant for a BMI increase of at least 2 kg/m in multivariable analyses (adjusted odds ratio [OR] 1.76, 95% CI 1.14-2.74 for 2 to less than 4 kg/m, adjusted OR 3.19, 95% CI 1.86-5.47 for 4 kg/m or more). Conversely, weight loss of 2 kg/m or more was associated with a decreased risk of a hypertensive disorder (adjusted OR 0.41, 95% CI 0.21-0.81). CONCLUSION:Among women with no hypertensive disorder noted in an index pregnancy, an increase in BMI of at least 2 kg/m between deliveries was independently associated with an increased risk of a hypertensive disorder in a subsequent pregnancy.

Project description:ImportanceWomen with a history of hypertensive disorders of pregnancy (HDP) have higher risk of cardiovascular disease (CVD). It is not known how much of the excess CVD risk in women with a history of HDP is associated with conventional cardiovascular risk factors.ObjectiveTo quantify the excess risk of CVD in women with a history of HDP and estimate the proportion associated with conventional cardiovascular risk factors.Design, setting, and participantsProspective cohort study with a median follow-up of 18 years. Population-based cohort of women participating in the Nord-Trøndelag Health Study in Norway. We linked data for 31 364 women from the Nord-Trøndelag Health Study (1984-2008) to validated hospital records (1987-2015), the Cause of Death Registry (1984-2015), and the Medical Birth Registry of Norway (1967-2012). A total of 7399 women were excluded based on selected pregnancy characteristics, incomplete data, or because of emigrating or experiencing the end point before start of follow-up, leaving 23 885 women for study. Data were analyzed between January 1, 2018, and June 6, 2018.ExposuresExperiencing 1 or more pregnancies complicated by HDP before age 40 years vs only experiencing normotensive pregnancies.Main outcomes and measuresWe used Cox proportional hazards models to estimate the hazard ratios (HRs) for the association between HDP and CVD. The proportion of excess risk associated with conventional cardiovascular risk factors was estimated using an inverse odds ratio weighting approach.ResultsOur study population consisted of 23 885 parous women from Nord-Trøndelag County, Norway. A total of 21 766 women had only normotensive pregnancies, while 2199 women experienced ever having an HDP. From age 40 to 70 years, women with history of HDP had an increased risk of CVD compared with women with only normotensive pregnancies (HR, 1.57; 95% CI, 1.32-1.87) but not at older age (β = 0.98; 95% CI, 0.96-1.00; P for interaction by age = .01). Blood pressure and body mass index were associated with up to 77% of the excess risk of CVD in women with history of HDP, while glucose and lipid levels were associated with smaller proportions.Conclusion and relevanceIn this study, the risk of excess CVD in women with history of HDP was associated with conventional cardiovascular risk factors, indicating that these risk factors are important targets for cardiovascular prevention in these women.

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Hypertensive disorders of pregnancy and subsequent maternal cardiovascular health.

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Hypertensive disorders of pregnancy and subsequent maternal cardiovascular health.

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