Hypertensive pregnancy disorders raise CVD risks within 2 years postpartum

Hypertensive disorders of pregnancy were associated with greater risks for certain cardiovascular diseases within 24 months of delivery, according to a presenter at The Pregnancy Meeting.

“It is well-established that hypertensive disorders of pregnancy confer substantial increased risk of cardiovascular disease, stroke and hypertension later in life. This often culminates in mortality decades after birth,” Christina M. Ackerman-Banks, MD, an assistant professor at Baylor College of Medicine in Houston, said during the presentation. “However, in the postpartum period, most existing data on cardiovascular disease is from 6 weeks postpartum up to 12 months.”

Using data from the Maine Health Data Organization’s All-Payer Claims Database, Ackerman-Banks and colleagues identified 119,445 singleton pregnancies among people with continuous insurance and no preexisting CVD who delivered between 2007 and 2019. The researchers assessed the risks for heart failure, ischemic heart disease, arrhythmia/cardiac arrest, cardiomyopathy, cerebrovascular disease/stroke and chronic hypertension within 24 months. They also assessed the likelihood of composite severe cardiac disease, comprising heart failure, cerebrovascular disease and cardiomyopathy.

Hypertensive disorders of pregnancy were associated with greater risks for new chronic hypertension (adjusted HR = 7.29; 95% CI, 6.57-8.09), heart failure (aHR = 2.81; 95% CI, 1.9-4.15), cerebrovascular disease (aHR = 1.43; 95% CI, 1.07-1.91), cardiomyopathy (aHR = 2.9; 95% CI, 1.96-4.27) and severe cardiac disease (aHR = 1.9; 95% CI, 1.54-2.36). There were no associations between hypertensive pregnancy disorders and ischemic heart disease or cardiac arrest/arrhythmia.

Among patients with hypertensive disorders of pregnancy, new chronic hypertension, arrhythmia/cardiac arrest and ischemic heart disease were diagnosed “fairly uniformly” during the first 24 months after delivery, according to the presentation. However, 50% of cardiomyopathy cases were diagnosed during the first month postpartum, and 33% of heart failure cases were diagnosed during the first month postpartum. After month one, new diagnoses increased steadily for both, according to the presentation.

“Our results have the potential to inform targeted postpartum intervention strategies that focus specifically on the cardiovascular disease risks that are increased postpartum,” Ackerman-Banks said. “In order to achieve this, collaboration with primary care physicians and cardiologists is critical, as are advocacy efforts for expansion of maternity care beyond the initial postpartum.”