Hypertensive disorders during pregnancy were linked with increased rates of chronic hypertension, hypercholesterolemia and type 2 diabetes later in life, researchers found from a large prospective study.
Nurses Health Study II participants with either gestational hypertension or preeclampsia during their first pregnancies had higher rates of all three later on -- often beginning soon after birth, reported Jennifer J. Stuart, ScD, of Harvard T.H. Chan School of Public Health in Boston, and colleagues.
Moreover, these risks were the most pronounced within five years after giving birth, the authors wrote in the Annals of Internal Medicine.
They noted that the 2011 American Heart Association guidelines recommend that clinicians evaluate risk for cardiovascular disease by screening for a history of hypertensive disorders of pregnancy, but "few data exist on which risk factors should be screened for as well as the frequency and timing of screening."
Indeed, they added that previous studies examining hypertensive disorders of pregnancy and risks of cardiovascular risk factors down the road were "limited by small sample size; short follow-up; or incomplete adjustment for potential confounders," and were conducted over variable lengths of time.
"Little is known about the specific timing of risk factor development, which is critical to inform screening guidelines," they wrote.
Researchers examined data from the Nurses' Health Study II, which was restricted to those participants who responded to the 2009 questionnaire. In this questionnaire, women also retrospectively reported their pregnancy history, including self-reported hypertensive disorders of pregnancy, self-reported risk factors for cardiovascular disease, as well was their lifestyle factors and medical history.
Overall, 58,671 participants were included, with first births occurring from 1964 and 2008. Median age at first birth was about 27. About 9% of women had hypertensive disorders of pregnancy, with almost 3% developing gestational hypertension and about 6% developing preeclampsia.
The authors noted that by the end of the follow-up period in 2013, over 55% of women had developed hypercholesterolemia, a third developed chronic hypertension and about 6% had type 2 diabetes.
Adjusted models found that compared to normotensive women, women with gestational hypertension had almost a threefold increased rate of chronic hypertension (adjusted HR 2.79, 95% CI 2.67-2.97) and women with preeclampsia had a more than two-fold increased rate (adjusted HR 2.21, 95% CI 2.10-2.32).
Indeed, the authors found that women who were hypertensive during their first pregnancy had a 70% increased rate of type 2 diabetes and a 30% increased rate of hypercholesterolemia.
When examining these risk factors by 5-year intervals, women with gestational hypertension had a more than fourfold increased rate of chronic hypertension in the first 5 years following their first birth (adjusted HR 4.29, 95% CI 3.16-5.84) and women with preeclampsia had similar increased rates of chronic hypertension (adjusted HR 3.96, 95% CI 3.07-5.11) versus normotensive women.
An accompanying editorial by Abigail Fraser, PhD, of the University of Bristol in England, noted the fact that women with hypertensive disorders of pregnancy developed cardiovascular risk factors at an earlier age, and cited recent U.S. and European guidelines, including 2016 guidelines published in the European Heart Journal and a joint advisory from the AHA and the American College of Obstetricians and Gynecologists (ACOG) that suggested a woman's obstetric history should be included as a cardiovascular risk factor, and should be monitored by a primary care physician or cardiologist years after the pregnancy.
"[The study] suggests that women with a history of HDP could benefit from cardiovascular risk assessment at an earlier age than those without [hypertensive disorders of pregnancy]," she wrote. "Additional prospective studies with repeatedly measured CVD risk factors in postpartum women are needed to build on the present study findings and to further inform monitoring practices in women with a history of [hypertensive disorders of pregnancy]."
Stuart and colleagues noted that the main limitation to their findings was that hypertensive disorders of pregnancy were retrospectively self-reported in the 2009 questionnaire, raising the question of recall bias.
This study was supported by the NIH and the American Heart Association.
Stuart disclosed support from the National Heart, Lung and Blood Institute and the National Institute of Child and Human Development.
One co-author disclosed support from the Ruth L. Kirschstein National Research Service Award.
Fraser disclosed support from U.K. government grants.
Annals of Internal Medicine
Source Reference: Stuart JJ, et al "Hypertensive disorders of pregnancy and maternal cardiovascular disease risk factor development" Ann Intern Med 2018; DOI: 10.7326/M17-2740.
Annals of Internal Medicine
Source Reference: Fraser A "Women's cardiovascular health after a hypertensive disorder of pregnancy" Ann Intern Med 2018; DOI: 10.7326/M18-1443.
Read the original article on Medpage Today:Hypertension in Pregnancy May Foretell Lifetime of Problems