In the Journals

Hypertensive disorders during pregnancy increase risk for CVD later

Women who experience gestational hypertension or preeclampsia during pregnancy have a higher likelihood of developing CVD risk factors, including high BP, type 2 diabetes and high cholesterol, later in life, according to research published in Annals of Internal Medicine.

“Women with a history of hypertensive disorders of pregnancy are nearly twice as likely to develop CVD as those who are normotensive during pregnancy,” Jennifer J. Stuart, ScD, from Harvard T.H. Chan School of Public Health, and colleagues wrote. “However, the emergence of CVD risk factors after [hypertensive disorders of pregnancy] is less well-understood.”

Stuart and colleagues performed an observational cohort study to determine whether hypertensive disorders of pregnancy, such as gestational hypertension and preeclampsia, are associated with maternal CVD risk factors, including chronic hypertension, type 2 diabetes and hypercholesterolemia. The researchers analyzed data of 58,671 parous women who participated in the Nurses’ Health Study II and did not have CVD, chronic hypertension, type 1 or 2 diabetes, hypercholesterolemia, myocardial infarction or stroke prior to or at baseline. Participants were followed from their first birth for a mean of 25 to 32 years.

Data showed that women with gestational hypertension (2.9%) during their first pregnancy were more likely to have chronic hypertension (HR = 2.8; 95% CI, 2.6-3), type 2 diabetes (HR = 1.7; 95% CI, 1.4-1.9) and hypercholesterolemia (HR = 1.4; 95% CI, 1.3-1.5) throughout follow-up, compared with those who were normotensive during pregnancy. Women with preeclampsia (6.3%) in their first pregnancy also had increased rates of chronic hypertension (HR = 2.2; 95% CI, 2.1-2.3), type 2 diabetes (HR = 1.8; 95% CI, 1.6-1.9) and hypercholesterolemia (HR = 1.3; 95% CI, 1.3 to 1.4).

Women’s risk for chronic hypertension was highest within 5 years after their first birth. Recurring hypertensive disorders of pregnancy increased the risk of developing CVD risk factors.

Additionally, CVD risk factors developed earlier in women with a history of hypertensive disorders of pregnancy than those without said history.

“Women [with gestational hypertension or preeclampsia] may benefit from lifestyle interventions and screening to reduce cardiovascular risk and delay disease onset,” Stuart and colleagues concluded. “Just as guidelines exist to screen for [type 2 diabetes] among women with a history of gestational diabetes, our findings may inform similar guidelines on screening for CVD risk factors among women with a history of [hypertensive disorders of pregnancy].”

In an accompanying editorial, Abigail Fraser, BA, MA, MPH, PhD, from Bristol Medical School, United Kingdom, wrote that the findings by Stuart and colleagues offer important new information to inform recommendations for optimal monitoring and prevention of CVD.

“CVD is the leading cause of death among women in the United States and globally, and more than 80% of U.S. women have children,” she wrote. “Pregnancy may therefore provide an opportunity to identify CVD, intervene and ultimately reduce the disease burden in women. Stuart and colleagues’ findings strengthen the case for investing in this research agenda to reduce the burden of CVD in women.” – by Alaina Tedesco

Disclosure: Fraser reports receiving support from UK Medical Research Council. Stuart and colleagues report no relevant financial disclosures.

Women who experience gestational hypertension or preeclampsia during pregnancy have a higher likelihood of developing CVD risk factors, including high BP, type 2 diabetes and high cholesterol, later in life, according to research published in Annals of Internal Medicine.

“Women with a history of hypertensive disorders of pregnancy are nearly twice as likely to develop CVD as those who are normotensive during pregnancy,” Jennifer J. Stuart, ScD, from Harvard T.H. Chan School of Public Health, and colleagues wrote. “However, the emergence of CVD risk factors after [hypertensive disorders of pregnancy] is less well-understood.”

Stuart and colleagues performed an observational cohort study to determine whether hypertensive disorders of pregnancy, such as gestational hypertension and preeclampsia, are associated with maternal CVD risk factors, including chronic hypertension, type 2 diabetes and hypercholesterolemia. The researchers analyzed data of 58,671 parous women who participated in the Nurses’ Health Study II and did not have CVD, chronic hypertension, type 1 or 2 diabetes, hypercholesterolemia, myocardial infarction or stroke prior to or at baseline. Participants were followed from their first birth for a mean of 25 to 32 years.

Data showed that women with gestational hypertension (2.9%) during their first pregnancy were more likely to have chronic hypertension (HR = 2.8; 95% CI, 2.6-3), type 2 diabetes (HR = 1.7; 95% CI, 1.4-1.9) and hypercholesterolemia (HR = 1.4; 95% CI, 1.3-1.5) throughout follow-up, compared with those who were normotensive during pregnancy. Women with preeclampsia (6.3%) in their first pregnancy also had increased rates of chronic hypertension (HR = 2.2; 95% CI, 2.1-2.3), type 2 diabetes (HR = 1.8; 95% CI, 1.6-1.9) and hypercholesterolemia (HR = 1.3; 95% CI, 1.3 to 1.4).

Women’s risk for chronic hypertension was highest within 5 years after their first birth. Recurring hypertensive disorders of pregnancy increased the risk of developing CVD risk factors.

Additionally, CVD risk factors developed earlier in women with a history of hypertensive disorders of pregnancy than those without said history.

“Women [with gestational hypertension or preeclampsia] may benefit from lifestyle interventions and screening to reduce cardiovascular risk and delay disease onset,” Stuart and colleagues concluded. “Just as guidelines exist to screen for [type 2 diabetes] among women with a history of gestational diabetes, our findings may inform similar guidelines on screening for CVD risk factors among women with a history of [hypertensive disorders of pregnancy].”

In an accompanying editorial, Abigail Fraser, BA, MA, MPH, PhD, from Bristol Medical School, United Kingdom, wrote that the findings by Stuart and colleagues offer important new information to inform recommendations for optimal monitoring and prevention of CVD.

“CVD is the leading cause of death among women in the United States and globally, and more than 80% of U.S. women have children,” she wrote. “Pregnancy may therefore provide an opportunity to identify CVD, intervene and ultimately reduce the disease burden in women. Stuart and colleagues’ findings strengthen the case for investing in this research agenda to reduce the burden of CVD in women.” – by Alaina Tedesco

Disclosure: Fraser reports receiving support from UK Medical Research Council. Stuart and colleagues report no relevant financial disclosures.