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Hypertension risk remains high years after pregnancy
Women who had a hypertensive disorder during pregnancy had a threefold to 10-fold increased risk for hypertension in the decade following pregnancy, according to new data published in BMJ.
It is estimated that 10% of pregnancies are complicated by hypertensive disorders of pregnancy, according to the study background.
“Women with a hypertensive disorder of pregnancy have increased risks of post-pregnancy hypertension, ischemic heart disease and stroke, which has prompted changes to guidelines by the American Heart Association and the European Society of Cardiology to include hypertensive disorders of pregnancy as risk factors for CVD in women,” Ida Behrens, MD, of the department of epidemiology research at Statens Serum Institut in Copenhagen, Denmark, and colleagues wrote. “However, clinical awareness of the link between hypertensive disorders of pregnancy and CVD is incomplete, which may result in delayed diagnosis and jeopardize the health of these women.”
Behrens and colleagues compared risk for postpregnancy hypertension in 1,025,118 women who had a live or stillbirth from 1978 to 2012 and 482,972 women whose first delivery occurred in or after 1995.
Among women who gave birth after 1995, 23,235 developed pregnancy-related hypertension during their first pregnancy and 16,611 women developed hypertension at follow-up.
Among women who did not develop hypertension after delivery, the rate of hypertension in within the decade following delivery was 4% for women with a first pregnancy in her 20s, 5.7% for women with a first pregnancy in her 30s and 11.3% for women with a first pregnancy in her 40s, according to the findings.
The incidence of hypertension continued to increase by age among women with hypertension during pregnancy in her 20s (13.7%), 30s (20.3%) and 40s (32.4%), according to the findings.
The researchers calculated that the rate of postpregnancy hypertension increased 12-fold to 25-fold in women with pregnancy-related hypertension compared with those without hypertensive disorders of pregnancy. Women with pregnancy-related hypertension had a 3- to 10-fold increased risk from 1 to 10 years after delivery. The risk persisted and remained twice as high 20 years or more after delivery.
“In the quest to minimize the lifetime impact of hypertensive disorders of pregnancy on women’s postpregnancy health, we now need data, particularly from randomized clinical trials, to support clinical decision making and policy on clinical follow-up for women with a history of hypertensive disorders of pregnancy,” Behrens and colleagues wrote. – by Darlene Dobkowski
Disclosures: Behrens reports receiving a grant from the Danish Counsel for Independent Research and the Danish Heart Association. Please see the full study for a list of the other authors’ relevant financial disclosures.