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Long-Term Outcomes of Hypertensive Disorders of Pregnancy
Quick Takes
- Women with hypertensive disorders of pregnancy are at increased cardiovascular risk.
- Women with hypertensive disorders of pregnancy (HDP) are more likely to experience stroke, CAD, heart failure, CKD, hypertension, and diabetes compared to women who do not have HDP.
- Incidence of HDP reported per-pregnancy may underestimate the number of women with HDP.
Study Questions:
What is the incidence of hypertensive disorders of pregnancy (HDP) and the association with future chronic conditions?
Methods:
The investigators used data from a population-based cohort, the Rochester Epidemiology Project, and linked medical records to identify residents of Olmsted County, MN, who delivered infants between 1976 and 1982. Pregnancies of ≥20 weeks were identified and classified as normotensive, gestational hypertension, pre-eclampsia, eclampsia, pre-eclampsia superimposed on chronic hypertension, and chronic hypertension using a validated electronic algorithm. The incidence of HDP was calculated for pre-pregnancy and per-woman. The primary outcomes of future chronic conditions included stroke, coronary artery disease (CAD), cardiac arrhythmias, chronic kidney disease (CKD), and multimorbidity.
Results:
A total of 7,544 women with 9,862 pregnancies were identified between 1976 and 1982 with sufficient information to be included in this analysis. During the 6 years of assessment, 659 women were identified with a total of 719 (7.3%) HDP pregnancies, and 324 (3.3%) had pre-eclampsia. The per-pregnancy incidence rate was 7.3% (95% confidence interval [CI], 6.8%-7.9%) for HDP, including 0.04% for eclampsia and 3.3% for pre-eclampsia. The incidence per-woman calculation was based on a subcohort of 1,839 women with sufficient information available for all pregnancies. The per-woman incidence was twice that of their incidence rates observed per-pregnancy: 15.3% and 7.5% for HDP and pre-eclampsia, respectively. The median number of pregnancies was two per woman. In terms of future events, women with a history of HDP were at increased risk for subsequent diagnoses of stroke (hazard ratio [HR], 2.27; 95% CI, 1.37-3.76), CAD (HR, 1.89; 95% CI, 1.26-2.82), cardiac arrhythmias (HR, 1.62; 95% CI, 1.28-2.05), CKD (HR, 2.41; 95% CI, 1.54-3.78), and multimorbidity (HR, 1.25; 95% CI, 1.15-1.35).
Conclusions:
The investigators concluded that women with HDP are at significant risk for chronic conditions, including CAD, stroke, and CKD. Furthermore, incidence expressed per-pregnancy underestimated the number of women with HDP.
Perspective:
These data support the need to assess HDP as a cardiovascular risk factor when addressing preventive assessment in women as they age. In addition, reporting rates of HDP per-pregnancy appears to underestimate the rates compared to reporting rates per-woman.
Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Prevention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Hypertension
Keywords: Arrhythmias, Cardiac, Blood Pressure, Coronary Artery Disease, Eclampsia, Hypertension, Pregnancy-Induced, Pre-Eclampsia, Pregnancy, Primary Prevention, Renal Insufficiency, Chronic, Risk Factors, Stroke, Vascular Diseases
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