Assessing cardiovascular disease risk in women with a history of hypertensive disorders of pregnancy: A guidance paper for studies using administrative data

Abstract

BackgroundHypertensive disorders of pregnancy (HDP) are a major cause of maternal morbidity and mortality, and their association with increased cardiovascular disease (CVD) risk represents a major public health concern. However, assessing CVD risk in women with a history of these conditions presents unique challenges, especially when studies are carried out using routinely collected data.ObjectivesTo summarise and describe key challenges related to the design and conduct of administrative studies assessing CVD risk in women with a history of HDP and provide concrete recommendations for addressing them in future research.MethodsThis is a methodological guidance paper.ResultsSeveral conceptual and methodological factors related to the data‐generating mechanism and study conceptualisation, design/data management and analysis, as well as the interpretation and reporting of study findings should be considered and addressed when designing and carrying out administrative studies on this topic. Researchers should develop an a priori conceptual framework within which the research question is articulated, important study variables are identified and their interrelationships are carefully considered.ConclusionsTo advance our understanding of CVD risk in women with a history of HDP, future studies should carefully consider and address the conceptual and methodological considerations outlined in this guidance paper. In highlighting these challenges, and providing specific recommendations for how to address them, our goal is to improve the quality of research carried out on this topic.

Harnessing women's full reproductive history in assessing cardiovascular risk

“…The paper by Johnston et al 2 includes a detailed illustration of the hypothesised pathological mechanisms underlying these associations.…”

“…How can we achieve this? Johnston et al 2 point to the remaining questions on the heterogeneity of HDP and CVD phenotypes. There is an important design aspect to explore the association between HDP and later CVD:…”

“…All of this information is vital to moving us towards an understanding of which women are actually at high risk after experiencing HDP. Cross-sectional studies or studies focusing on first pregnancies, as also discussed by Johnston et al, 2 do not take this aspect into account. Women who stop reproduction after a first pregnancy complicated by preterm preeclampsia have a 9-fold higher risk of CVD mortality compared to women with two or more pregnancies without preeclampsia.…”

“…In this special issue of Paediatric and Perinatal Epidemiology, Johnston and colleagues 2 propose a set of guidelines for studies using administrative data that aim to explore the risks of cardiovascular disease (CVD) risk in women with a history of HDP. They document key, important features to be aware of when planning studies to explore the associations between HDP and CVD.…”