Pregnancy-Induced Hypertension and Diabetes and the Risk of Cardiovascular Disease, Stroke, and Diabetes Hospitalization in the Year Following Delivery

Abstract

Although pregnancy events predict the long-term risk of chronic disease, little is known about their short-term impact because of the rarity of clinical events. We examined hospital discharge diagnoses linked to birth certificate data in the year following delivery for 849,639 births during 1995-2004 in New York City, New York. Adjusted odds ratios characterized the relationship between pregnancy complications and subsequent hospitalization for cardiovascular disease, stroke, and diabetes. Gestational hypertension was related to heart failure (adjusted odds ratio = 2.6, 95% confidence interval: 1.5, 4.5). Preeclampsia was related to all of the outcomes considered except type 1 diabetes, with adjusted odds ratios ranging from 2.0 to 4.1. Gestational diabetes was strongly related to the risk of subsequent diabetes (for type 1 diabetes, adjusted odds ratio = 40.4, 95% confidence interval: 23.8, 68.5; for type 2 diabetes, adjusted odds ratio = 22.6, 95% confidence interval: 16.9, 30.4) but to no other outcomes. The relationship of pregnancy complications to future chronic disease is apparent as early as the year following delivery. Moreover, elucidating short-term clinical outcomes offers the potential for etiological insights into the relationship between pregnancy events and chronic disease over the life course.

Preeclampsia and Future Cardiovascular Health

“…For instance, only 2 of the 4 studies that examined heart failure had adjusted for pre-existing cardiovascular disease before delivery. 23,35 Preeclampsia and cardiovascular diseases are known to share risk factors. According to the American College of Obstetricians and Gynecologists, the recognized risk factors for preeclampsia are obesity, chronic hypertension, diabetes mellitus, chronic renal disease, previous preeclampsia, systemic lupus erythematosus, age >40 years, primiparity, multiple pregnancy, in vitro fertilization, and family history of preeclampsia.…”

“…For coronary heart disease, there was a 2-fold increased risk of events with preeclampsia (RR, 2.11; 95% CI, 1.60-2.77; I 2 =87%; 3 239 797 participants). The risk was even greater in the adjusted studies 10,19,23,25,31,35,37 (aRR, 2.50; 95% CI, 1.43-4.37; I 2 =89%; 2 068 673 participants). The heterogeneity was mainly driven by the study by Lin et al 23 ; if this study was excluded, heterogeneity was reduced to 66% in The risk of composite cardiovascular disease and cardiovascular disease death with preeclampsia is shown in Figure I in the Data Supplement and Figure 5.…”

“…Four studies recruited primiparous women only, 8,19,24,26 whereas 17 studies included women of any parity. [9][10][11]23,25,[27][28][29][30][31][32][33][34][35][36][37][38] Studies reporting a mean or median age at enrollment ranged from 23.4 to 32.3 years, whereas follow-up ranged from 6 weeks postpartum to 39.4 years.…”

“…Nineteen studies had reliable methods of ascertaining preeclampsia from databases, 8,9,19,[23][24][25][26]30,32,35,36 medical records, 10,11,20,28,34 prospective measurements, 29,33 or through completion of questionnaire with trained staff. 30,31 Nineteen studies used reliable methods of obtaining cardiovascular outcomes from databases, [8][9][10]19,[23][24][25][26]28,32,[34][35][36] medical records, 11 prospective measurements with echocardiography, 33,38 or through completion of questionnaire with trained staff. [29][30][31] There was adequate follow-up (>90%) in 17 studies.…”

“…[29][30][31] There was adequate follow-up (>90%) in 17 studies. 8,9,11,[23][24][25][26][27][28][30][31][32][33][34][35][36]38 Eighteen studies used adjusted analyses. 8,9,19,20,[23][24][25][26][28][29][30][31][32][33][35][36][37][38] …”