Hypertensive Disorders in Pregnancy Associated With Increased Risk for CVD Postpartum

Women with hypertensive disorders in pregnancy (HDP) have an increased risk for the development of cardiovascular disease (CVD) and hypertension postpartum, according to a study published in Paediatric and Perinatal Epidemiology.

Using the United Kingdom’s Clinical Practice Research Datalink (CPRD), researchers identified 146,748 women between aged 15 to 45 years with a first recorded delivery between 1990 and 2013.

Full-term delivery was classified with a gestational age of 40 weeks and women who had a diagnosis of hypertension before 18 weeks of gestation were excluded from the study. Follow-up was 4.7 years for the primary outcome of CVD and 4.4 years for the secondary outcome of hypertension. Approximately 70% of participants had 1 pregnancy, 30.1% of participants had 2 pregnancies, and less than 1% of participants had 3 or more pregnancies during the study period.

Results demonstrated that 1.8% (n=6433) of participants had 1 pregnancy affected by HDP, .6% (n=421) of participants had ≥2 pregnancies with HDP, and 95.6% (n=140,315) of participants did not have a pregnancy with HDP. Women with HDP exhibited certain characteristics such as being overweight or obese, having diabetes, or having family histories of CVD and hypertension. 

During the follow-up period, 997 participants had incident CVD. In women with HDP, the rate of subsequent CVD was 2 times higher (hazard ratio [HR], 2.2, 95% CI, 1.7-2.7) than in women with no history of HDP. Approximately 6812 participants were diagnosed with hypertension or received a prescription for antihypertensive medication during the follow-up period. In women with HDP, the rate of hypertension was recorded as 5 times higher than that of women without HDP (HR, 5.6; 95% CI, 5.1-6.3).

The researchers noted that previous studies have suggested that the presence of preeclampsia/eclampsia may result in a higher risk for the development of traditional risk factors for CVD, but it is still not known whether preeclampsia contributes directly to CVD or is an early marker. “The inconclusive findings in this study, with respect to women with preeclampsia/eclampsia, may in part be explained by the use of a GP [general practitioner] database, which may be less likely to fully capture women followed by obstetricians.”

In addition, the CPRD may be including women with a less severe form of preeclampsia who deliver at full term and have a similar risk for CVD as women with other forms of HDP.

Women with a history of HDP may need closer long-term follow-up to monitor the development of CVD risk factors.

Reference

Grandi SM, Vallée-Pouliot K, Reynier P, et al. Hypertensive disorders in pregnancy and the risk of subsequent cardiovascular disease [published online August 17, 2017]. Paediatr Perinat Epidemiol. doi:10.1111/ppe.12388