Hypertension in Pregnancy Has Lingering Effects

(MedPage Today) — Development of a hypertensive pregnancy disorder was associated with greater risks of adverse cardiovascular and renal outcomes for the mother later in life, researchers affirmed.

Among women followed after a successful delivery, those with gestational hypertension or preeclampsia during pregnancy had higher rates of hypertension, renal disease, and stroke in their 40s and beyond (P<0.01 for all), according to Vesna Garovic, MD, of the Mayo Clinic in Rochester, Minn.

The result is consistent with previous research linking hypertensive pregnancy disorders with greater risks of cardiovascular and renal disease, she reported at the American Society of Nephrology meeting here.

The association could be explained by risk factors common to both preeclampsia and cardiovascular and renal disease — including endothelial dysfunction — or by metabolic and vascular changes induced by preeclampsia, Garovic said.

“In that case, treatment of hypertensive pregnancy disorders … may become even more important,” she said, “as it would not only improve immediate maternal and fetal outcomes, but may have major implications for the prevention of future cardiovascular disease and improvement in women’s lives.”

Garovic and her colleagues set out to overcome some of the limitations associated with previous studies examining the long-term risks of hypertensive pregnancy disorders — including small sample sizes, short follow-up, and use of self-reported outcomes — by using the population-based Rochester Epidemiology Project, which has collected data from individuals living in Olmsted County, Minn., since 1966.

The analysis was restricted to women who gave birth from 1976 to 1982 (at an average age of 26) and had follow-up data after age 40. Diagnostic codes were used to identify pregnancies complicated by hypertensive disorders and long-term cardiovascular and renal disease outcomes.

Overall, the study included 465 women with a hypertensive disorder during pregnancy and 3,898 with a pregnancy free from complications.

On average, women who had a hypertensive disorder had their first cardiovascular or renal disease event six years earlier than the controls (44 versus 50, P<0.0001).

They were more likely to have a diagnostic code for hypertension (51% versus 31%), some type of renal disease (14% versus 10%), and stroke (8% versus 4%). Overall, the rate of any cardiovascular or renal disease event was 61% in the women with a complicated pregnancy and 47% in the controls. All differences were statistically significant at P<0.01.

Currently, the only successful treatment for preeclampsia is immediate delivery of the child, which results in preterm birth and a high rate of fetal mortality — up to 10%, according to a member of Garovic’s group, Iasmina Craici, MD, now at Saint Louis University.


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