Objective
To assess whether pre‐eclampsia (PE)‐related placental/extraplacental membrane findings are linked to moderately elevated blood pressure (BP) in pregnancy and later‐life hypertension.
Design
Prospective cohort.
Setting
52 prenatal clinics, 5 Michigan communities.
Sample
The POUCH Study recruited women at 16–27 weeks’ gestation (1998–2004) and studied a sub‐cohort in depth. This sample (n = 490) includes sub‐cohort women with detailed placental assessments and cardiovascular health evaluations 7–15 years later in the POUCHmoms follow‐up study.
Methods
PE‐related placental/extraplacental membrane findings (i.e. mural hyperplasia, unaltered/abnormal vessels or atherosis in decidua; infarcts) were evaluated in relation to pregnancy BP and odds of Stage 2 hypertension at follow up using weighted polytomous regression. Follow‐up hypertension odds also were compared in three pregnancy BP groups: normotensives (referent) and moderately elevated BP with or without PE‐related placental/extraplacental membrane findings.
Main outcome measures
Stage 2 hypertension (SBP ≥140 mmHg and/or DBP ≥90 mmHg, or using antihypertensive medications) at follow up.
Results
After excluding women with pregnancy hypertension (i.e. chronic, PE, gestational), mural hyperplasia and unaltered/abnormal decidual vessels were each associated with Stage 2 hypertension at follow up: adjusted odds ratio (aOR) = 2.7, 95% CI 1.1–6.6, and aOR = 1.7 (95% CI 0.8–3.4), respectively. Women with moderately elevated BP in pregnancy and evidence of mural hyperplasia or unaltered/abnormal decidual vessels had greater odds of Stage 2 hypertension at follow up: aOR = 4.5 (95% CI 1.6–12.5 and aOR = 2.6, 95% CI 1.1–5.9, respectively.
Conclusions
PE‐related placental/extraplacental membrane findings help risk‐stratify women with moderately elevated BP in pregnancy for later development of hypertension.
Tweetable Abstract
Placental findings associated with mother’s risk of later‐life hypertension.
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