May 04, 2020
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Future CVD risk associated with hypertension during pregnancy underestimated

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Michael C. Honigberg

Expressing the incidence of hypertensive disorders of pregnancy, or HDP, per pregnancy underestimates the number of women affected by HDP compared with expressing HDP per woman, according to a study published in the Journal of the American College of Cardiology.

The study also found that women with a history of HDP had an increased risk for future chronic conditions and multimorbidity.

“By only looking at HDP rates per pregnancy, we have been vastly underestimating the number of women who are affected by this condition and may be at risk for future heart or kidney disease,” Vesna D. Garovic, MD, PhD, professor of medicine in the department of internal medicine and obstetrics and gynecology at Mayo Clinic, said in a press release. “Looking at the per woman rate allowed us to assess women with more than one pregnancy who may have had HDP including preeclampsia during one of her pregnancies but not the other.”

Researchers analyzed data from 9,862 pregnancies from 7,544 women between 1976 and 1982. A validated electronic algorithm was used to classify pregnancies as gestational hypertension, normotensive, eclampsia, preeclampsia, chronic hypertension and preeclampsia superimposed on chronic hypertension.

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Women with hypertensive disorders of pregnancy may have elevated CV risks for CAD, stroke and cardiac arrhythmia.

The six primary outcomes were CAD, cardiac arrhythmias, stroke, congestive HF, dementia and chronic kidney disease.

Among the cohort, 7.3% of pregnancies were in a woman with HDP and 3.3% were in a woman with preeclampsia. When assessed on a per-woman basis, the incidence rate was 15.3% for HDP and 7.5% for preeclampsia.

Women with a history of HDP had elevated risk in later life for CAD (HR = 1.89; 95% CI, 1.26-2.82), stroke (HR = 2.27; 95% CI, 1.37-3.76), chronic kidney disease (HR = 2.41; 95% CI, 1.54-3.78), cardiac arrhythmias (HR = 1.62; 95% CI, 1.28-2.05) and multimorbidity (HR = 1.25; 95% CI, 1.15-1.35).

Pradeep Natarajan

In a related editorial, Michael C. Honigberg, MD, MPP, cardiology fellow at Massachusetts General Hospital and Harvard Medical School, and Pradeep Natarajan, MD, MMSc, director of preventive cardiology at Massachusetts General Hospital and assistant professor of medicine at Harvard Medical School, wrote: “Efforts to improve HDP prediction and prevention before pregnancy may yield long-term maternal health benefits, in addition to important short-term benefits to mother and child. Ultimately, discovery of effective, targeted risk-reducing interventions for women with HDP would make pregnancy an even more actionable and powerful screening test.” – by Darlene Dobkowski

Disclosures: Garovic reports no relevant financial disclosures. Honigberg reports he received grants from the NHLBI. Natarajan reports he received grants from Amgen, Apple, Boston Scientific, Fondation Leducq, a Hassenfeld award from the Massachusetts General Hospital and the NHLBI and consultant fees from Apple. Please see the study for all other authors’ relevant financial disclosures.

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