Preeclampsia, Gestational Hypertension Increases CVD Risk Later in Life

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Women who reported hypertensive disorders during pregnancy were more likely to report developing CVD risk factors sooner than women who were normotensive.
Women who reported hypertensive disorders during pregnancy were more likely to report developing CVD risk factors sooner than women who were normotensive.

Women with hypertensive disorders of pregnancy (HDP) are more likely to experience hypertension, type 2 diabetes, and hypercholesterolemia for several years after pregnancy, according to a study published in the Annals of Internal Medicine.1

Researchers analyzed responses to the 2009 follow-up questionnaire of the Nurses' Health Study II (NHS II), which enrolled US registered female nurses in 1989. A total of 58,671 parous participants without cardiovascular disease (CVD) or CVD risk factors at baseline were included in the observational analysis. Participants reported whether they were hypertensive or normotensive during pregnancy, as well as whether they had experienced a subsequent diagnosis of chronic hypertension, hypercholesterolemia, or type 2 diabetes from birth up to 2013.

Participants with preeclampsia (6.3%) or gestational hypertension (2.9%) during their first pregnancy were more likely to report increased rates of subsequent chronic hypertension (hazard ratio [HR], 2.8 [95% CI, 2.6-3.0] vs 2.2 [95% CI, 2.1-2.3], respectively), type 2 diabetes (HR, 1.7 [95% CI, 1.4-1.9] vs 1.8 [95% CI, 1.6-1.9]), and hypercholesterolemia (HR, 1.4 [95% CI, 1.3-1.5] vs 1.3 [95% CI, 1.3-1.4]) compared with women who were normotensive during pregnancy.

Women who reported HDP during their first pregnancy were also more likely to report developing CVD risk factors sooner than women without HDP (P <.001), and women with HDP were also likely to develop these risk factors at earlier ages compared with women who were normotensive during their pregnancy (P <.001).

The reliance on self-reported HDP, preeclampsia status, and confounders is a primary limitations of the study.

Findings from this analysis indicated that women with HDP "may benefit from lifestyle interventions and screening to reduce cardiovascular risk and delay disease onset."

In an accompanying editorial,2 Abigail Fraser, BA, MA, MPH, PhD suggested that pregnancy itself "may therefore provide an opportunity to identify CVD, intervene, and ultimately reduce the disease burden in women."

References

1. Stuart JJ, Tanz LJ, Missmer SA, et al. Hypertensive disorders of pregnancy and maternal cardiovascular disease risk factor development: an observational cohort study [published online July 3, 2018]. Ann Intern Med. doi:10.7326/M17-2740

2. Fraser A. Women's cardiovascular health after a hypertensive disorder of pregnancy [published online July 3, 2018]. Ann Intern Med. doi:10.7326/M18-1443

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