Provoking factors for postpartum chronic hypertension in women with preceding gestational hypertension/preeclampsia: A longitudinal cohort study of 22,798 pregnancies

Chen, Kuo-Hu; Chen, Li–Ru

doi:10.7150/ijms.39432

Cited by 8 publications

(8 citation statements)

References 24 publications

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“…PE is the main cause of maternal and fetal mortality and morbidity (19,20). GDM complicated by PE further increases perinatal adverse events (21)(22)(23)(24), future maternal risk of chronic hypertension, cardiovascular disease, and diabetes (25)(26)(27); offspring body mass index (BMI) also steadily increases over time (28). Identifying factors associated with occurrence of PE in women with GDM, especially those that are controllable, is important for improving pregnancy outcomes.…”

Section: Introductionmentioning

confidence: 99%

Gestational Diabetes Mellitus and Preeclampsia: Correlation and Influencing Factors

Yang

2022

Front. Cardiovasc. Med.

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Gestational diabetes mellitus (GDM) and preeclampsia (PE) are common pregnancy complications with similar risk factors and pathophysiological changes. Evidence from previous studies suggests that the incidence of PE is significantly increased in women with GDM, but whether GDM is independently related to the occurrence of PE has remained controversial. GDM complicated by PE further increases perinatal adverse events with greater impact on the future maternal and offspring health. Identify factors associated with PE in women with GDM women, specifically those that are controllable, is important for improving pregnancy outcomes. This paper provides the findings of a review on the correlation between GDM and PE, factors associated with PE in women with GDM, possible mechanisms, and predictive markers. Most studies concluded that GDM is independently associated with PE in singleton pregnancy, and optimizing the treatment and management of GDM can reduce the incidence of PE, which is very helpful to improve pregnancy outcomes.

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Section: Introductionmentioning

confidence: 99%

Gestational Diabetes Mellitus and Preeclampsia: Correlation and Influencing Factors

Yang

2022

Front. Cardiovasc. Med.

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“…The follow-up of HDP patients for 5-21 years after delivery demonstrated that they had a four-fold higher risk of developing PHTN than those without HDP [ 6 , 8 , 21 ]. One-year follow-up studies showed that PHTN occurred in 17-29% of patients with PE after discharge and that the probability of postpartum CVD was significantly higher in the PE group than in those with normal pregnancies; among those with PE, the BP returned to normal [ 12 , 13 , 22 , 30 ]. The 13.4% incidence of PHTN among the 1,000 PE subjects here reflects the morbidity of persistent PHTN in Taiyuan City, Shanxi Province, China.…”

Section: Discussionmentioning

confidence: 99%

“…Current PE models mostly involve the early prediction of adverse pregnancy outcomes and long-term cardiovascular disease risk [ 19 – 21 ]. Prognostic data on BP profiles at short-term follow-up during the postpartum period in patients with PE are scarce, although some other risk factors of PHTN have been suggested, including preexisting hypertension before pregnancy and a higher body mass index (BMI) [ 11 ], older age, smoking, pre-pregnancy obesity, comorbidities such as thyroid disorders [ 12 ], and decreased serum placental growth factor [ 22 ]. Few studies to date have reported the clustered and combined effects of multiple risk factors on BP recovery during the 3-month or longer period after delivery in patients with PE.…”

Section: Introductionmentioning

confidence: 99%

Screening high-risk population of persistent postpartum hypertension in women with preeclampsia using latent class cluster analysis

Cao

et al. 2022

BMC Pregnancy Childbirth

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Background A significant proportion of women with preeclampsia (PE) exhibit persistent postpartum hypertension (PHTN) at 3 months postpartum associated with cardiovascular morbidity. This study aimed to screen patients with PE to identify the high-risk population with persistent PHTN. Methods This retrospective cohort study enrolled 1,000 PE patients with complete parturient and postpartum blood pressure (BP) profiles at 3 months postpartum. The enrolled patients exhibited new-onset hypertension after 20 weeks of pregnancy, while those with PE superimposed upon chronic hypertension were excluded. Latent class cluster analysis (LCCA), a method of unsupervised learning in machine learning, was performed to ascertain maternal exposure clusters from eight variables and 35 subordinate risk factors. Logistic regression was applied to calculate odds ratios (OR) indicating the association between clusters and PHTN. Results The 1,000 participants were classified into three exposure clusters (subpopulations with similar characteristics) according to persistent PHTN development: high-risk cluster (31.2%), medium-risk cluster (36.8%), and low-risk cluster (32.0%). Among the 1,000 PE patients, a total of 134 (13.4%) were diagnosed with persistent PHTN, while the percentages of persistent PHTN were24.68%, 10.05%, and 6.25% in the high-, medium-, and low-risk clusters, respectively. Persistent PHTN in the high-risk cluster was nearly five times higher (OR, 4.915; 95% confidence interval (CI), 2.92–8.27) and three times (OR, 2.931; 95% CI, 1.91–4.49) than in the low- and medium-risk clusters, respectively. Persistent PHTN did not differ between the medium- and low-risk clusters. Subjects in the high-risk cluster were older and showed higher BP, poorer prenatal organ function, more adverse pregnancy events, and greater medication requirement than the other two groups. Conclusion Patients with PE can be classified into high-, medium-, and low-risk clusters according to persistent PHTN severity; each cluster has cognizable clinical features. This study’s findings stress the importance of controlling persistent PHTN to prevent future cardiovascular disease.

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“…2 Prior research has demonstrated that a substantial proportion of persons with preeclampsia will have persistent hypertension up to five years after delivery and long-term risk of developing chronic hypertension. 3,4 In these studies, associated risk factors for persistent hypertension included excessive gestational weight gain, presence of gestational diabetes mellitus, preeclampsia with severe features, dyslipidemia and age greater than 40. [4][5][6] Identifying modifiable risk factors for persistent hypertension may help to reduce long-term consequences and the associated health burden of postpartum preeclampsia.…”

Section: Introductionmentioning

confidence: 99%

“…3,4 In these studies, associated risk factors for persistent hypertension included excessive gestational weight gain, presence of gestational diabetes mellitus, preeclampsia with severe features, dyslipidemia and age greater than 40. [4][5][6] Identifying modifiable risk factors for persistent hypertension may help to reduce long-term consequences and the associated health burden of postpartum preeclampsia.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with persistent hypertension one year postpartum in persons with gestational hypertension or preeclampsia

Livergood

Mahlum

Hauck

et al. 2022

Preprint

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Objective: To identify factors associated with persistent hypertension one-year postpartum after pregnancy complicated by gestational hypertension or preeclampsia. Study Design: A retrospective case-control study of postpartum patients who had a diagnosis of gestation hypertension or preeclampsia during a recent pregnancy and attended one-year postpartum annual exam and blood pressure check between 2014 and 2019 in a single academic medical center. Cases were defined as persons with persistent hypertension one year postpartum, using the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines, defining stage I hypertension as systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥80 mmHg. Controls were defined as non-pregnant persons with normal blood pressure (BP) at one year postpartum. Using bivariate and multivariate analyses, demographic, clinical and labor characteristics were compared between persons who had persistent hypertension one-year postpartum and controls. Results: Of the 595 persons included in this analysis, 268 (45.0%) had persistent hypertension one year postpartum. Bivariate analyses demonstrated that older maternal age, higher body mass index (BMI) at first prenatal visit, at delivery, and one year postpartum, mild-range BP (compared to normal BP) prior to discharge, and patients with elevated BP at 6-week postpartum visit, were more likely to have persistent hypertension one-year postpartum. In contrast, nulliparity was associated with lower risk of having persistent hypertension at one-year postpartum. Multivariate logistic regression demonstrated that mild range BP prior to discharge (aOR 1.78, 95%CI 1.16-2.72), elevated BPs at 6 weeks postpartum (aOR 2.01, 95% CI 1.36-3.00), and higher BMI at one-year postpartum (aOR 1.07, 95%CI 1.00-1.14), remained to be significantly associated with higher odds of persistent hypertension one-year postpartum, while nulliparity remained to be associated with lower odds of persistent hypertension one-year postpartum (aOR 0.55, 95%CI 0.36-0.84) Conclusion: In this cohort, 45% of patients with gestational hypertension or preeclampsia had persistent hypertension one-year postpartum by the 2017 ACC/AHA hypertension definition. Patients that had mildly elevated BPs in the immediate postpartum period as well as at 6 weeks postpartum, and higher BMI one year postpartum, had higher risk of having at least stage I HTN one year following pregnancy complicated by gestational hypertension or preeclampsia.

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Provoking factors for postpartum chronic hypertension in women with preceding gestational hypertension/preeclampsia: A longitudinal cohort study of 22,798 pregnancies

Cited by 8 publications

References 24 publications

Gestational Diabetes Mellitus and Preeclampsia: Correlation and Influencing Factors

Gestational Diabetes Mellitus and Preeclampsia: Correlation and Influencing Factors

Screening high-risk population of persistent postpartum hypertension in women with preeclampsia using latent class cluster analysis

Factors associated with persistent hypertension one year postpartum in persons with gestational hypertension or preeclampsia

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