Association of Adverse Pregnancy Outcomes With Hypertension 2 to 7 Years Postpartum

Haas, David M.; Parker, Corette B.; Marsh, Derek J.; Grobman, William A.; Ehrenthal, Deborah B.; Greenland, Philip; Merz, C. Noel Bairey; Pemberton, Victoria L.; Silver, Robert M.; Barnes, Shannon; McNeil, Rebecca B.; Cleary, Kirsten; Reddy, Uma M.; Chung, Judith H.; Parry, Samuel; Theilen, Lauren; Blumenthal, Elizabeth; Levine, Lisa D.; Mercer, Brian M.; Simhan, Hyagriv N.; Polito, LuAnn; Wapner, Ronald J.; Catov, Janet M.; Chen, Ida; Saade, George R.

doi:10.1161/jaha.119.013092

Cited by 91 publications

(104 citation statements)

References 38 publications

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“…The Nurses’ Health Study II demonstrated that women who reported a first pregnancy affected by HDP presented higher rates of hypertension (hazard ratio [HR] 2.8; 95% CI 2.6–3.0), type 2 diabetes mellitus (HR 1.7; 95% CI 1.4–1.9) and hypercholesterolaemia (HR 1.4; 95% CI 1.3–1.5) within 5 years postpartum 37 . A recent prospective observational cohort that followed 4484 women for a mean of 3.2 years after their first pregnancy showed that women with any hypertensive disorder of pregnancy had a higher adjusted risk of hypertension at follow up compared with controls (relative risk [RR] 2.7; 95% CI 2.0–3.6) 38 . Moreover, a register‐based study showed that women with HDP had twice the risk of cardiovascular readmissions (acute myocardial infarction, stroke or heart failure) within 3 years compared with women with normal pregnancies 39 .…”

Section: Discussionmentioning

confidence: 99%

Incidence of postpartum hypertension within 2 years of a pregnancy complicated by pre‐eclampsia: a systematic review and meta‐analysis

Giorgione

Ridder

Kalafat

et al. 2020

BJOG

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Background Women with a history of hypertensive disorders of pregnancy (HDP) are at increased long-term risk of cardiovascular disease. However, there has been increasing evidence on the same risks in the months following birth. Objectives This review aims to estimate the incidence of hypertension in the first 2 years after HDP. Search strategy MEDLINE, Embase and Cochrane databases were systematically searched in October 2019. Selection criteria Observational studies comparing hypertension rate following HDP and normotensive pregnancies up to 2 years. Data collection and analysis A meta-analysis to calculate the odds ratio (OR) with a 95% confidence interval (CI) and a subgroup analysis excluding women with chronic hypertension were performed. Main results Hypertension was diagnosed within the first 2 years following pregnancy in 468/1646 (28.4%) and 584/6395 (9.1%) of the HDP and control groups, respectively (OR 6.28; 95% CI 4.18-9.43; I 2 = 56%). The risk of hypertension in HDP group was significantly higher in the first 6 months following delivery (OR 18.33; 95% CI 1.35-249.48; I 2 = 84%) than at 6-12 months (OR 4.36; 95% CI 2.81-6.76; I 2 = 56%) or between 1-2 years postpartum (OR 7.24; 95% CI 4.44-11.80; I 2 = 9%). A subgroup analysis demonstrated a similar increase in the risk of developing postpartum hypertension after HDP (OR 5.75; 95% CI 3.92-8.44; I 2 = 49%) and pre-eclampsia (OR 6.83; 95% CI 4.25-10.96; I 2 = 53%). Conclusions The augmented risk of hypertension after HDP is highest in the early postpartum period, suggesting that diagnosis and targeted interventions to improve maternal cardiovascular health may need to be commenced in the immediate postpartum period.

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Section: Discussionmentioning

confidence: 99%

Incidence of postpartum hypertension within 2 years of a pregnancy complicated by pre‐eclampsia: a systematic review and meta‐analysis

Giorgione

Ridder

Kalafat

et al. 2020

BJOG

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“…In that study, authors reported that women with any hypertensive disorder in pregnancy were more than two times as likely to have hypertension at follow-up (RR 2.7, 95% CI 2.0-3.6). 43 Others found significant increases in high BP as soon as two years postpartum in women with hypertensive disorders of pregnancy, though that sample consisted of primarily white women (from the United Kingdom) as well. 44 Another study reported a significant increase in hypertension risk 12 months postpartum for obese women with preeclampsia (OR 2.35, 95% CI 1.63-3.41).…”

Section: Discussionmentioning

confidence: 95%

“…Most studies 42 looked at cardiovascular outcomes such as heart disease, myocardial infarction, or death, and not a more short-term outcome such as hypertension. Haas et al 43 reported findings of a prospective cohort study of 4484 women followed for 2-7 years after their first pregnancy. Women in this study were recruited from eight centers across the United States and were primarily white (62.1%), and few were African American (13.8%).…”

Section: Discussionmentioning

confidence: 99%

High blood pressure in pregnancy, DNA methylation, and later blood pressure in African American women enrolled in the InterGEN Study

Barcelona

Wang

Crusto

et al. 2020

Birth

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Background Few studies have examined the effects of high blood pressure (BP) in pregnancy, preeclampsia, or eclampsia on later BP, and the epigenetics of this phenomenon is similarly poorly understood, especially among African Americans. The purpose of this study was to examine the association between high BP in pregnancy, epigenomics, and later BP in African American women in the InterGEN Study (n = 250). Methods In cross‐sectional analyses, regression and linear mixed‐effects models were employed to examine the effects of high BP in pregnancy on: (a) epigenetic associations (DNA methylation) and (b) BP 3‐5 years after birth. The 850K Illumina EPIC BeadChip was used for evaluating epigenome‐wide DNA methylation. High BP in pregnancy, preeclampsia, or eclampsia was self‐reported by women, and BP was measured 3‐5 years after birth, per JNC‐7 guidelines. DNA methylation and clinical BP were the main outcomes. Results Mean age of enrolled women was 31.2 years, 21.8% were smokers, 58% had some college or higher education, 46.6% reported an annual income <$15 000, and 13.6% reported high BP in pregnancy. After adjustment for obesity, smoking, and age, women with a history of high BP in pregnancy had significantly higher BP than those who did not report this complication (5.39 ± 2.4 mm Hg, P = .030). Epigenome‐wide analysis revealed no significant sites after multiple testing correction. Conclusions We observed a small, but clinically significant, increase in BP in women who reported high BP in pregnancy 3‐5 years after that pregnancy. Future studies with larger sample sizes should examine epigenetic contributions to this finding.

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“…have not yet been adequately studied or implemented, to our knowledge. [24][25][26][27] Prior studies have…”

Section: Discussionmentioning

confidence: 99%

Racial Differences in Postpartum Blood Pressure Trajectories Among Women After a Hypertensive Disorder of Pregnancy

et al. 2020

Self Cite

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Key Points Question Does postpartum blood pressure trajectory after a hypertensive disorder of pregnancy differ by race? Findings In this prospective cohort study that included 1077 women after a hypertensive disorder of pregnancy, blood pressure trajectories evaluated using mixed-effects linear regression models differed significantly by self-reported race. At the conclusion of the study, 68% of Black women and 51% of White women met the criteria for stage 1 or stage 2 hypertension. Meaning This study suggests that postpartum blood pressure trajectories indicate persistence of higher blood pressures among Black women in this cohort, which may have important implications for postpartum morbidity and mortality associated with hypertensive and cardiovascular conditions in this population.

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Association of Adverse Pregnancy Outcomes With Hypertension 2 to 7 Years Postpartum

Cited by 91 publications

References 38 publications

Incidence of postpartum hypertension within 2 years of a pregnancy complicated by pre‐eclampsia: a systematic review and meta‐analysis

Incidence of postpartum hypertension within 2 years of a pregnancy complicated by pre‐eclampsia: a systematic review and meta‐analysis

High blood pressure in pregnancy, DNA methylation, and later blood pressure in African American women enrolled in the InterGEN Study

Racial Differences in Postpartum Blood Pressure Trajectories Among Women After a Hypertensive Disorder of Pregnancy

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