C ardiovascular disease (CVD) has gained interest in obstetrics in recent years because large observational studies revealed a remarkable increase in the long-term risk of CVD in women who experienced different types of gestational hypertensive disorders.1-3 These include pregnancy-induced hypertension (PIH) and preeclampsia, which affect 2% to 7% of all pregnancies worldwide. 4A review by Bellamy et al 1 showed an increase of the postpartum risk of CVD events according to the severity of the hypertensive pregnancy disorder, with the highest risk in women who experienced early-onset preeclampsia. Women with a normal pregnancy have an advantage according to these results, but still develop CVD later in life. Currently, it is not possible to identify individual women who have the highest risk in developing CVD. In recent years, other studies did reveal that common modifiable risk factors such as fasting blood glucose and lipid levels are significantly elevated 6 months after a pregnancy complicated by early-onset preeclampsia .5-8 The dose-response relationship with the severity of a hypertensive pregnancy disorder and future CVD suggest that the differences in long-term CVD risk between women with a history of a hypertensive pregnancy may be dependent on variation in the underlying maternal CVD risk profiles. However, studies that compare cardiovascular risk factors between women with a previous pregnancy complicated by early-onset preeclampsia, late-onset preeclampsia, or PIH within the same population are lacking.In this study, we compare CVD risk profiles ≥3 months postpartum between women with previous early-onset preeclampsia, term preeclampsia and term gestational hypertension. We hypothesize that there is a difference in the prevalence of modifiable CVD risk factors postpartum between women with a history of a hypertensive disorder of pregnancy. Identification of women at high risk of CVD at a relatively young age may provide an opportunity for early personalized follow-up and prevention.Abstract-Observational studies have shown an increased lifetime risk of cardiovascular disease (CVD) in women who experienced a hypertensive disorder in pregnancy. This risk is related to the severity of the pregnancy-related hypertensive disease and gestational age at onset. However, it has not been investigated whether these differences in CVD risk factors are already present at postpartum cardiovascular screening. We evaluated postpartum differences in CVD risk factors in 3 subgroups of patients with a history of hypertensive pregnancy. We compared the prevalence of common CVD risk factors postpartum among 448 women with previous early-onset preeclampsia, 76 women with previous late-onset preeclampsia, and 224 women with previous pregnancy-induced hypertension. Women with previous early-onset preeclampsia were compared with women with late-onset preeclampsia and pregnancy-induced hypertension and had significantly higher fasting blood glucose (5.29 versus 4.80 and 4.83 mmol/L), insulin (9.12 versus 6.31 and 6.7 uIU/L), ...

In women with a history of HTP, hypertension and metabolic syndrome are more common, and they have higher levels of biochemical cardiovascular risk factors 2.5 years after pregnancy.

BackgroundCardiovascular disease is associated with major morbidity and mortality in women in the Western world. Prediction of an individual cardiovascular disease risk in young women is difficult. It is known that women with hypertensive pregnancy complications have an increased risk for developing cardiovascular disease in later life and pregnancy might be used as a cardiovascular stress test to identify women who are at high risk for cardiovascular disease. In this study we assess the possibility of long term cardiovascular risk prediction in women with a history of hypertensive pregnancy disorders at term.MethodsIn a longitudinal follow-up study, between June 2008 and November 2010, 300 women with a history of hypertensive pregnancy disorders at term (HTP cohort) and 94 women with a history of normotensive pregnancies at term (NTP cohort) were included. From the cardiovascular risk status that was known two years after index pregnancy we calculated individual (extrapolated) 10-and 30-year cardiovascular event risks using four different risk prediction models including the Framingham risk score, the SCORE score and the Reynolds risk score. Continuous data were analyzed using the Student’s T test and Mann–Whitney U test and categorical data by the Chi-squared test. A poisson regression analysis was performed to calculate the incidence risk ratios and corresponding 95% confidence intervals for the different cardiovascular risk estimation categories.ResultsAfter a mean follow-up of 2.5 years, HTP women had significantly higher mean (SD) extrapolated 10-year cardiovascular event risks (HTP 7.2% (3.7); NTP 4.4% (1.9) (p<.001, IRR 5.8, 95% CI 1.9 to 19)) and 30-year cardiovascular event risks (HTP 11% (7.6); NTP 7.3% (3.5) (p<.001, IRR 2.7, 95% CI 1.6 to 4.5)) as compared to NTP women calculated by the Framingham risk scores. The SCORE score and the Reynolds risk score showed similar significant results.ConclusionsWomen with a history of gestational hypertension or preeclampsia at term have higher predicted (extrapolated) 10-year and 30-year cardiovascular event risks as compared to women with a history of uncomplicated pregnancies. Further large prospective studies have to evaluate whether hypertensive pregnancy disorders have to be included as an independent variable in cardiovascular risk prediction models for women.