Earlier Age of Onset of Chronic Hypertension and Type 2 Diabetes Mellitus After a Hypertensive Disorder of Pregnancy or Gestational Diabetes Mellitus

Abstract

C ardiovascular diseases (CVD) are the primary cause of death in women. 1 In the past decade, it has become clear that there is a strong relation of common complications of pregnancy, such as hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM), with future CVD events in women. [2][3][4][5][6] The findings have been acknowledged by the American Heart Association 2011 in its Guidelines on the Prevention of Cardiovascular Disease in Women, which stipulate that healthcare professionals should obtain pregnancy history as part of routine clinical intake and evaluate cardiovascular risk factors.1 Moreover, in the guidelines for the prevention of stroke in women, the American Heart Association recommends that women with preeclampsia should be evaluated 6 months to 1 year postpartum to assess and treat potential cardiovascular risk factors, including hypertension, obesity, smoking, and dyslipidemia. 7A considerable proportion of women develop a complication of pregnancy. GDM affects as much as 5% to 9% of pregnancies, 8 whereas ≈10% of pregnancies are complicated by high blood pressure. 9,10 The latter can be subdivided into preeclampsia and pregnancy-induced hypertension. Although these conditions generally subside after delivery, many of these women are predisposed to develop future type 2 diabetes mellitus (T2D), hypertension, and CVD. [11][12][13][14][15][16][17] As most studies focused on the risk of developing these cardiovascular risk factors, little is known about the time frame (years after the pregnancy) in which a woman with a history of HDP or GDM develops T2D and hypertension. [11][12][13][14][15][16][17] This information is of importance for the timing of effective screening programs to reduce the risk of CVD in women with these complications of pregnancy. Furthermore, it is unknown whether complications of pregnancy are independently associated with the risk Abstract-A prospective cohort study was conducted to assess the impact of a history of hypertensive disorder of pregnancy (HDP) or gestational diabetes mellitus (GDM) on the risk and age of onset of hypertension, type 2 diabetes mellitus (T2D), and cardiovascular disease (CVD) later in life, independent of hypertension and T2D. Between 1993 and 1997, 22 265 ever-pregnant women were included from the European Prospective Investigation into Cancer and Nutrition-NL study, aged 20 to 70 years at baseline. Details on complications of pregnancy and known hypertension were obtained by questionnaire. Blood pressure was measured at enrollment. Participants were followed for the occurrence of CVD events. Data were analyzed using ANCOVA, multivariable logistic regression, and Cox proportional hazard (with HDP and GDM as time-dependent variables for T2D and CVD) models. At enrollment, women with a HDP reported diagnosis of hypertension 7.7 years earlier (95% confidence interval [CI] 6.9-8.5) and women with GDM reported diagnosis of T2D 7.7 years earlier (95% CI 5.8-9.6) than women without pregnancy complications. After adjustment fo...

Life Course Trajectories of Cardiovascular Risk Factors in Women With and Without Hypertensive Disorders in First Pregnancy: The HUNT Study in Norway

“…Our results were generally consistent with previous studies in showing that women with HDP had adverse levels of cardiovascular risk factors at various time points from before first pregnancy and until menopause,6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17 with correspondingly increased risks of hypertension, obesity, and diabetes mellitus 13, 14, 15, 39, 40, 41, 42. Our study adds to the limited evidence beyond age 50 years, confirming that except for lipids, for which trajectories converge by age 60 years, other differences in cardiovascular risk factors persist until age 60 years.…”

Pregnancy‐Related Risk Factors Are Associated With a Significant Burden of Treated Hypertension Within 10 Years of Delivery: Findings From a Population‐Based Norwegian Cohort

“…In the Netherlands component of the EPIC (European Prospective Investigation Into Cancer and Nutrition), hypertension and type 2 DM fully accounted for the association between self‐reported hypertension in a prior pregnancy and later‐life CVD 22. The excess risk of future CVD associated with pregnancy‐related events could, theoretically, be mitigated by early detection, preventive action, and pharmacological treatment.…”

“…Furthermore, prepregnancy maternal body mass index (BMI; kg/m 2 ), blood pressure, and lipid measurements accounted for a large percentage of the postpregnancy differences in these risk factors between women with and without PE/GH 19. Several recent studies, however, have evaluated multiple relevant covariates in analyses of the association between pregnancy‐related events and future maternal CVD end points 11, 15, 20, 21, 22. The multivariable adjustment for numerous covariates has resulted in attenuation in the measures of association with CVD outcomes.…”

Association of Higher Maternal Blood Pressure With Lower Infant Birthweight

“…Furthermore, both preeclampsia and SGA share prepregnancy risk factors that are remarkably similar to those of cardiovascular disease, and these pregnancy complications predispose to postpartum long-term development of maternal cardiovascular morbidity and mortality risks. 4,8 These long-term cardiovascular risks are evident and corroborated from large-scale, populationbased epidemiological studies from several countries, but it is difficult to convincingly attribute the cause to abnormal placentation. Given this growing evidence, the authors should be congratulated for starting a discussion on the real possibility that SGA infants, stillbirth, and even preeclampsia may be consequences of the inability of the maternal cardiovascular system to cope with the significant volume load of pregnancy.…”