Increased Cardiac Arrhythmia After Pregnancy‐Induced Hypertension: A South Korean Nationwide Database Study

Abstract

Background Although pregnancy‐induced hypertension (PIH) is associated with an elevated cardiovascular risk, long‐term studies or prepregnancy baseline data are scarce. Therefore, using a large nationwide cohort with prepregnancy periodic health screening data, we investigated whether clinically significant arrhythmia incidence increases after PIH. Methods and Results Data were extracted from the Korea National Health Insurance database and combined with the National Health Screening Examination database; women who gave birth between 2007 and 2015 and underwent the national health screening test within a year before pregnancy were followed up until 2016. We excluded women who had a diagnosis of arrhythmia within 1 year before pregnancy. The primary outcome was significant arrhythmia during the year after delivery. Secondary analysis included only specific diagnostic codes of arrhythmia with clinical significance. Additionally, the risk of arrhythmia was stratified by the use of magnesium sulfate. Of 2 035 684 women (PIH; n=37 297 versus normotensive pregnancy; n=1 998 387), the PIH group had a higher prepregnancy risk profile and showed a higher incidence of arrhythmia than women with normotensive pregnancies within 1 year. Women with PIH had a significantly higher risk of atrial flutter/fibrillation and atrioventricular block, but not lethal arrhythmias. Other predictors of arrhythmia development included advanced maternal age and cesarean section. Stratified analysis showed a higher risk of arrhythmia with magnesium sulfate use. Conclusions PIH was significantly associated with the development of arrhythmia within 1 year after delivery. Nevertheless, the incidence of lethal arrhythmias was not increased by PIH. Arrhythmia, especially atrial fibrillation, may largely contribute to increasing the future cardiovascular risk in women with a PIH history.

Risk of future cardiovascular diseases in different years postpartum after hypertensive disorders of pregnancy: A systematic review and meta-analysis

“…[ 39 , 42 , 45 , 50 ] Nine studies did not clearly state outcomes of interest in the methods of the studies. [ 36 , 39 , 40 , 42 , 54 , 55 , 58 , 72 , 80 ] Only 21 studies clearly showed the adjustment for both key confounding factors (age, smoking, and body mass index) and other factors, [ 37 , 38 , 43 , 45 , 51 , 53 , 54 , 56 , 57 , 59 , 61 , 64 , 68 , 69 , 73 , 77 , 81 , 84 , 88 , 89 , 91 ] while 8 studies did not adjust for any factors. [ 44 , 50 , 60 , 71 , 85 – 87 , 92 ] Adequate follow-up duration was reported in 27 studies.…”

“…Ntlemo, 2021 [86] South Africa Prospective cohort Preeclampsia 150 163 NS Hypertension Nuckols, 2021 [87] United States Retrospective cohort Preeclampsia 23 38 1.5 (mean) Hypertension Oliver-Williams, 2022 [88] United Kingdom Retrospective cohort Gestational hypertension, preeclampsia 159,819 2,199,567 NS Cardiovascular diseases, stroke, myocardial infarction, heart failure, cardiomyopathy, cardiac arrhythmia Park, 2022 [89] Korea Retrospective cohort Gestational hypertension, preeclampsia or eclampsia 37,297 1,998,387 NS Cardiac arrhythmia…”

JAHA Spotlight on Pregnancy and Its Impact on Maternal and Offspring Cardiovascular Health

“…During the pregnancy, this can result in maternal hypertension and preeclampsia. Postpregnancy, as noted by Park et al 10 in this issue, hypertensive disorders of pregnancy were associated higher incidence of developing a cardiac arrhythmia in the year following the pregnancy. Although lethal arrhythmias were uncommon, there was an >2‐fold increase in incidence of atrial flutter/fibrillation in patients with preeclampsia compared with normotensive pregnancies in their study of >2 million women in the Korea National Health Insurance database.…”

Pregnancy-Related Complications and Incidence of Atrial Fibrillation: A Systematic Review

“…Of these, 12,502 (97.3%) were excluded, and 347 full-text articles were retrieved and screened. Following full-text screening, nine studies met the inclusion criteria [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. Of the nine included studies, one study [ 32 ] had a case–control design, and eight studies [ 27 , 28 , 29 , 30 , 31 , 33 , 34 , 35 ] were cohort studies, of which one study utilised data from a prospective cohort, [ 29 ] and seven used longitudinal data from electronic health records.…”

“…Following full-text screening, nine studies met the inclusion criteria [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. Of the nine included studies, one study [ 32 ] had a case–control design, and eight studies [ 27 , 28 , 29 , 30 , 31 , 33 , 34 , 35 ] were cohort studies, of which one study utilised data from a prospective cohort, [ 29 ] and seven used longitudinal data from electronic health records. [ 27 , 28 , 30 , 31 , 33 , 34 , 35 ] One of the included studies provided unpublished data (after contacting the author) on the incidence rate, median follow-up time and hazard ratios for preterm birth and pre-eclampsia with incident AF [ 27 ].…”