The risk of maternal ischaemic heart disease after gestational hypertensive disease

Abstract

aObjective The aim of this study was to investigate whether the risk of developing ischaemic heart disease (IHD) later in life increases with severity and recurrence of gestational hypertensive disease. Design Cross-sectional population-based study.Setting Sweden.Population Women (403,550) giving birth to their first child in Sweden, 1973Sweden, -1982. Of this cohort, 207,054 women who also gave birth to a second child during the same period were analysed separately. Methods All women were followed up for 15 years, starting 4 -14 years after the index pregnancy. Women who suffered from hypertensive disease during pregnancy were compared with women with normal pregnancies with regard to hospitalisation for, or death from, IHD during the follow up period. Main outcome measures Fatal or non-fatal IHD.Results The adjusted incidence rate ratio (IRR) for later development of IHD was 1.6 (95% CI 1.3-2.0) when the first pregnancy was complicated by gestational hypertension without proteinuria, 1.9 (95% CI 1.6 -2.2) for mild pre-eclampsia and 2.8 (95% CI 2.2 -3.7) for severe pre-eclampsia. Women with gestational hypertension in their first pregnancy but not in their second had an adjusted IRR of 1.9 (95% CI 1.5-2.4) for development of IHD. Women with hypertensive disease in both pregnancies had an IRR of 2.8 (95% CI 2.0 -3.9) compared with women with two normal pregnancies. Conclusion Severe hypertensive disease in pregnancy has a stronger association with later development of IHD than has mild hypertensive disease. Recurrent hypertensive disease is more strongly associated with IHD than is non-recurrent disease.

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

“…The role of GH combined with SGA and/or preterm delivery on future CVD has been addressed in a few studies 5, 20, 24, 28. These studies support our findings, but have limitations.…”

“…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.…”

“…There is a well‐established association between preeclampsia, alone or in combination with SGA infants and/or preterm delivery, and subsequent risk of maternal CVD 1, 2, 3, 5, 19, 20, 21, 22, 23. In a study from 2016, we showed a doubled risk of CVD when preeclampsia occurred alone and a 4‐fold risk when preeclampsia occurred in combination with SGA and/or preterm delivery 2.…”

Hypertensive Disorders of Pregnancy and Future Maternal Cardiovascular Risk

“…In addition to the severity of preeclampsia, recurrent preeclampsia and preeclampsia superimposed on chronic hypertension are also associated with additional increases in CVD risk 48, 49, 50. Women with recurrent preeclampsia have a higher incidence of cardiovascular hospitalization (281.4 versus 167.7 per 1000 women) and a shorter time to first cardiovascular event (12.7 versus 11.6 years) compared with women who experienced preeclampsia in only 1 pregnancy 49.…”

“…The risk of future CVD with GH has generally been found to be lower than that associated with preeclampsia38, 46, 50; however, some recent studies have actually identified a higher risk of CVD associated with GH. A study of a Finnish cohort with 39 years of follow‐up found that GH was associated with modestly higher CVD risk than preeclampsia (HR: 1.45 versus 1.40) 44.…”