Cardiovascular Risk Factors Mediate the Long-Term Maternal Risk Associated With Hypertensive Disorders of Pregnancy

Experiencing a hypertensive disorder of pregnancy increases risk for cardiovascular disease in later life. However, few studies have data available longer than 30 years after a delivery and not many have analyses that consider cardiovascular disease risk factors before pregnancy.

In this study, researchers asked how chronic hypertension, high cholesterol (called hypercholesterolemia), type 2 diabetes, and body mass index (a measurement of weight in relation to height) - all cardiovascular disease risk factors- may play a role in the relationship between a history of hypertensive disorder of pregnancy and cardiovascular disease. This study used data from the Nurses’ Health Study II- a cohort of over 110,000 female registered nurses in the US who were between 25-42 years old at enrollment in 1989 who are still in the study today. In this study, 60,379 women from the Nurses’ Health Study with at least one pregnancy, complete data, and no preexisting cardiovascular disease at time of pregnancy were included. 10% of women experienced a hypertensive disorder pregnancy in their first pregnancy. They were similar demographically to women with normotensive pregnancies, however those with a hypertensive disorder of pregnancy were more likely to be obese before pregnancy and have a parent with a premature cardiovascular event. After controlling for possible confounding variables that may increase or decrease a woman’s likelihood for cardiovascular disease, the study analysis showed those with a history of hypertensive disorder of pregnancy had a 63% increased rate of cardiovascular disease compared with women with a normotensive first pregnancy (women were about 61 years old and about 34 years postpartum at time of follow up). Among women with gestational hypertension, 80% of their increased risk for cardiovascular disease was accounted for by developing hypertension after pregnancy. Interestingly, about 40% of the risk for cardiovascular disease among women with preeclampsia specifically could not be explained by the established cardiovascular risk factors.

Take home message: This study shows a clear link between experiencing a hypertensive disorder of pregnancy and risk for cardiovascular disease in later life. These data support screening and treatment for the risk factors (chronic hypertension, hypercholesterolemia, type 2 diabetes, and obesity) to delay and prevent developing cardiovascular disease.

Link: https://www.sciencedirect.com/science/article/pii/S0735109722044862?via%3Dihub

Citation: Stuart JJ, Tanz LJ, Rimm EB, Spiegelman D, Missmer SA, Mukamal KJ, Rexrode KM, Rich-Edwards JW. Cardiovascular Risk Factors Mediate the Long-Term Maternal Risk Associated With Hypertensive Disorders of Pregnancy. J Am Coll Cardiol. 2022

About Research Roundup

Each quarter, our team of researchers reviews the most current studies related to hypertensive disorders of pregnancy and selects those studies they feel will be of greatest interest to our community to summarize.

Special thanks to our volunteer research team, who under the leadership of Dr. Elizabeth Sutton, make Research Roundup possible: Alisse Hauspurg, MD Felicia LeMoine, and MD Jenny Sones, PhD, DVM.