Hypertensive disorders of pregnancy and subsequent maternal cardiovascular health

Nienke E Bergen, Sarah Schalekamp-Timmermans, Jolien Roos-Hesselink, Jeanine E Roeters van Lennep, Vincent V W Jaddoe, Eric A P Steegers, Nienke E Bergen, Sarah Schalekamp-Timmermans, Jolien Roos-Hesselink, Jeanine E Roeters van Lennep, Vincent V W Jaddoe, Eric A P Steegers

Abstract

To examine associations between hypertensive pregnancy disorders and maternal cardiovascular disease (CVD) in later life. We examined the associations between blood pressure (BP) in pregnancy, gestational hypertension (GH) and preeclampsia (PE) with cardiovascular measurements 6 years after index pregnancy among 4912 women participating in the Generation R Study, the Netherlands. BP, left ventricular mass (LV mass), aortic root diameter (AOD), left atrial diameter, fractional shortening, and carotid-femoral pulse wave velocity (PWV). Early pregnancy systolic and diastolic BP were associated with more adverse maternal cardiovascular measurements and a higher incidence of chronic hypertension 6 years after pregnancy. GH was associated with a higher BP, a higher PWV, a larger AOD and an increased LV mass 6 years after index pregnancy. Compared to previous normotensive pregnancies these women had a sixfold increased risk to develop chronic hypertension after pregnancy (OR 6.6, 95% CI 4.6-9.5). Compared to women with a normotensive pregnancy, women with PE had a higher BP and a higher risk of chronic hypertension (OR 4.5, 95% CI 2.6-7.8) at follow-up. After adjustment for BMI at follow-up in all the analyses on GH, PE and cardiovascular measurements, effect estimates attenuated up to 65%, but remained significant. Both GH and PE are associated with markers of adverse maternal cardiovascular health after pregnancy with an increased risk of chronic hypertension. Women with GH and PE may be offered long-term cardiovascular follow-up incorporated in CVD risk management guidelines.

Keywords: Blood pressure; Cardiovascular follow-up; Hypertensive disorders; Pregnancy.

Conflict of interest statement

Conflict of interest

The authors declare that they have no conflicts of interest.

Human and animal rights

All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Figures

Fig. 1
Fig. 1
Combined associations of maternal early and late pregnancy blood pressure measures with cardiovascular outcomes (a–c) and the risk of hypertension (d) 6 years after pregnancy (n = 3551). Effect estimates or odds ratios (95% Confidence Interval) are from multivariable linear or logistic regression models, respectively. Results are from multiple imputed data. Women using anti-hypertensive medication at follow-up are excluded from regression analysis with cardiovascular outcomes (a,b,c) (n = 52). Hypertension (d) is defined as women using anti-hypertensive medication at follow-up and/or having, in two subsequent blood pressure readings, a systolic or diastolic blood pressure above 140 or 90 mmHg, respectively. Models are adjusted for maternal age at intake, visit interval, ethnicity, educational level, smoking, subsequent pregnancies between index and follow-up, and child’s sex

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