Life Course Trajectories of Cardiovascular Risk Factors in Women With and Without Hypertensive Disorders in First Pregnancy: The HUNT Study in Norway

Abstract

BackgroundWomen with hypertensive pregnancy disorders have adverse levels of cardiovascular risk factors. It is unclear how this adverse risk factor profile evolves during adult life. We compared life course trajectories of cardiovascular risk factors in women with preeclampsia or gestational hypertension in their first pregnancy to normotensive women.Methods and ResultsWe linked information on cardiovascular risk factors from the population‐based HUNT (Nord‐Trøndelag Health Study) surveys with pregnancy information from the Medical Birth Registry of Norway. Trajectories of cardiovascular risk factors were constructed for 22 308 women with a normotensive first pregnancy; 1092 with preeclampsia, and 478 with gestational hypertension in first pregnancy. Already before first pregnancy, women with preeclampsia in their first pregnancy had higher measures of adiposity, blood pressure, heart rate, and serum lipids and glucose compared with women with a normotensive first pregnancy. After first pregnancy, there was a parallel development in cardiovascular risk factor levels, but women with a normotensive first pregnancy had a time lag of >10 years compared with the preeclampsia group. There were no clear differences in risk factor trajectories between women with gestational hypertension and women with preeclampsia.ConclusionsWomen with hypertensive pregnancy disorders in their first pregnancy had an adverse cardiovascular risk factor profile before pregnancy compared with normotensive women, and the differences persisted beyond 50 years of age. Hypertensive disorders in pregnancy signal long‐term increases in modifiable cardiovascular risk factors, and may be used to identify women who would benefit from early prevention strategies.

Association of Conventional Cardiovascular Risk Factors With Cardiovascular Disease After Hypertensive Disorders of Pregnancy

“…Information about the most recently measured cardiovascular risk factors prior to the cardiovascular event or censoring was obtained from clinical measurements and serum samples collected at HUNT examinations. Details about the cardiovascular risk factors measurements have been reported previously 6 and are included in the eAppendix of the Supplement .…”

“…Additionally, separate mediation analyses were conducted for preeclampsia and gestational hypertension as well as for CVD subtypes (myocardial infarction, heart failure, and cerebrovascular events). Mediators may have been measured before (maximum of 484 women [2%]) or after pregnancies complicated by HDP, but because we do not postulate the association between HDP and CVD to be causal and because the differences in cardiovascular risk factors between women with and without HDP are largely similar prepregnancy vs postpregnancy and throughout the age range from 20 years to older than 50 years in this study population, 6 the timing of mediator measurement was less relevant. In 2 separate sensitivity analyses, we excluded women who had their cardiovascular risk factors measured before their first pregnancy and restricted the mediation analysis to women who had mediators measured at older than 40 years, the time where we ended exposure follow-up.…”

Management of hypertension in pregnancy — prevention, diagnosis, treatment and long-term prognosis. A position statement of the Polish Society of Hypertension, Polish Cardiac Society and Polish Society of Gynaecologists and Obstetricians

“…The Nord Trøndelag Health Study (HUNT) showed that women with a history of pregnancy-induced HT or PE in their first pregnancy had a higher pre-conception body mass index, waist circumference, blood pressure, heart rate, as well as glucose and triglyceride levels as compared to women without the history of pregnancy-induced HT or PE in their first pregnancy. After the first pregnancy, there was a parallel development in cardiovascular risk factor levels, but women with a normotensive first pregnancy had a time lag of 10 years compared with the PE group [221].…”

Cardiovascular risk profile at the age of 40–45 in women with previous hyperemesis gravidarum or hypertensive disorders in pregnancy: A population-based study

“…This is in line with previous studies (139-142), but we confirm it in a larger population. A recent Norwegian study investigated life course trajectories of cardiovascular risk factors in women with hypertensive disorders in pregnancy(143). The authors concluded that women with hypertensive disorders in pregnancy have adverse cardiovascular risk factor profiles before their first pregnancy, which remain higher compared to other women beyond 50 years of age.…”