Risk of post-pregnancy hypertension in women with a history of hypertensive disorders of pregnancy: nationwide cohort study

Abstract

Objectives To determine how soon after delivery the risk of post-pregnancy hypertension increases in women with hypertensive disorders of pregnancy and how the risk evolves over time. Design Nationwide register based cohort study. Setting Denmark. Populations 482 972 primiparous women with a first live birth or stillbirth between 1995 and 2012 (cumulative incidence analyses), and 1 025 118 women with at least one live birth or stillbirth between 1978 and 2012 (Cox regression analyses). Main outcome measures 10 year cumulative incidences of post-pregnancy hypertension requiring treatment with prescription drugs, and hazard ratios estimated using Cox regression. Results Of women with a hypertensive disorder of pregnancy in a first pregnancy in their 20s, 14% developed hypertension in the first decade post partum, compared with 4% of women with normotensive first pregnancies in their 20s. The corresponding percentages for women with a first pregnancy in their 40s were 32% and 11%, respectively. In the year after delivery, women with a hypertensive disorder of pregnancy had 12-fold to 25-fold higher rates of hypertension than did women with a normotensive pregnancy. Rates in women with a hypertensive disorder of pregnancy were threefold to 10-fold higher 1-10 years post partum and remained twice as high even 20 or more years later. Conclusions The risk of hypertension associated with hypertensive disorders of pregnancy is high immediately after an affected pregnancy and persists for more than 20 years. Up to one third of women with a hypertensive disorder of pregnancy may develop hypertension within a decade of an affected pregnancy, indicating that cardiovascular disease prevention in these women should include blood pressure monitoring initiated soon after pregnancy.

Hypertensive Disorders of Pregnancy and Future Maternal Cardiovascular Risk

“…The risk of hypertension after the combined exposure of preeclampsia and GH was greatest after 4 years (HR: 9.4; 95% CI, 8.0–11.0) and declined with increasing follow‐up time. A similar result was reported by Behrens et al, who found that in the year after delivery, women with HDP had 12‐ to 25‐fold higher rates of hypertension than did women with normotensive pregnancies 59. The rates remained 3‐ to 10‐fold higher from 1 to 10 years postpartum and decreased to roughly twice as high at ≥20 years postpartum.…”

Association Between Gestational Hypertension and Risk of Cardiovascular Disease Among 617 589 Norwegian Women

“…A possible relationship between GH and risk of maternal CVD has been studied to a much smaller extent. While several studies have reported a significant association between GH and subsequent CVD,5, 19, 20, 23, 24, 25, 26, 27, 28, 29, 30 only 4 of these had a comparable cohort size and a similar follow‐up time compared with our study 19, 20, 23, 29. None of these studies looked at the combined effects of GH, SGA infant, preterm delivery, and parity as predictors of subsequent CVD.…”

FIGO (International Federation of Gynecology and Obstetrics) Postpregnancy Initiative: Long‐term Maternal Implications of Pregnancy Complications—Follow‐up Considerations

“…studied approximately 6000 normotensive women who developed HDP and reported more than twice the risk for pre‐hypertension or hypertension in the year after delivery compared with those without HDP. A report by Behrens et al . found a 12–25‐fold higher rate of hypertension 1 year after birth among women with HDP compared with normotensive parturients.…”