Research pointers: Risk of subsequent thromboembolism for patients with pre-eclampsia

Walraven, Carl van; Mamdani, Muhammad; Cohn, Adam; Katib, Yasir; Walker, Mark; Rodger, Marc

doi:10.1136/bmj.326.7393.791

Cited by 53 publications

(40 citation statements)

References 6 publications

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“…10 Hannaford et al 15 reported a 1.6-fold higher risk of venous thromboembolism after preeclampsia; Kestenbaum et al 16 found a 3.0-fold greater risk of subsequent cardiovascular events after any type of hypertensive pregnancy disorders and 2.3-fold higher risk of venous thromboembolism after a pregnancy complicated by severe preeclampsia. van Walraven et al 27 found the risk of subsequent venous thromboembolism to be 2.2-fold higher after a pregnancy complicated by preeclampsia. However, a significant limitation of these studies is the lack of control for other pregnancy complications.…”

Section: Discussionmentioning

confidence: 99%

Hypertensive Pregnancy Disorders and Subsequent Cardiovascular Morbidity and Type 2 Diabetes Mellitus in the Mother

et al. 2009

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Abstract-Minimal data exist concerning the relationship between hypertensive pregnancy disorders and various subsequent cardiovascular events and the effect of type 2 diabetes mellitus on these. In a registry-based cohort study, we identified women delivering in Denmark from 1978 to 2007 with a first singleton (nϭ782 287) and 2 first consecutive singleton deliveries (nϭ536 419). The exposures were gestational hypertension and mild and severe preeclampsia. We adjusted for preterm delivery, small for gestational age, placental abruption, and stillbirth and, in a second model, we also adjusted for the development of type 2 diabetes mellitus. The end points were subsequent hypertension, ischemic heart disease, congestive heart failure, thromboembolic event, stroke, and type 2 diabetes mellitus. Key Words: pregnancy Ⅲ preeclampsia Ⅲ diabetes mellitus Ⅲ ischemia Ⅲ stroke Ⅲ vascular diseases Ⅲ epidemiology H ypertensive pregnancy disorders complicate Ϸ5% to 7% of all pregnancies, the incidence being higher in nulliparous compared with parous women. 1 These frequently interrelate with other complications, eg, preterm delivery and fetal growth restriction, as well as placental abruption and stillbirth; a "placenta-associated syndrome" has been proposed composed of these pregnancy complications. 2 In this aspect, the severity of the preeclampsia may be reflected in the coexisting of other pregnancy complications.Despite vigorous investigation in the pathophysiology of these disorders, a clear etiology remains elusive. Contributing factors that have been proposed include immunology 3 and nulliparity, 1 as well as thrombophilia, 4 and endothelial dysfunction, 5 including an antiangiogenic state, 6 obesity, 7 and factors of the metabolic syndrome. 8,9 These latter factors are also intimately related to the development of cardiovascular disease; indeed, several epidemiological studies have linked preeclampsia with later cardiovascular events. 10,11 The principal end points in previous follow-up studies of preeclampsia, other than death death, 12 have been ischemic heart disease 13 and stroke. 14 Other specific cardiovascular end points have been less well studied, 15,16 and only 1 study has focused on later diabetes mellitus. 17 In addition, only 2 studies have investigated the effect of the recurrence of hypertensive pregnancy disorders on the risk of subsequent ischemic heart disease but not other end points. 18,19 We have designed a study using the Danish National Registries investigating the association among the following: (1) hypertensive pregnancy disorders in a first pregnancy and later cardiovascular morbidity and type 2 diabetes mellitus;

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Section: Discussionmentioning

confidence: 99%

Hypertensive Pregnancy Disorders and Subsequent Cardiovascular Morbidity and Type 2 Diabetes Mellitus in the Mother

et al. 2009

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“…Women who develop HDP have an increased risk of ischemic heart disease (11-16), hypertension (12,15), stroke (14,15), venous thromboembolism (13,17), and mortality (14,16,18) over the long term. Greater weight gain, and the increased risk of overweight and obesity in middle age, is associated with an increased risk of cardiovascular disease, diabetes, cancers, and overall mortality (19)(20)(21)).…”

Section: Discussionmentioning

confidence: 99%

The Association of Hypertensive Disorders of Pregnancy with Weight Gain over the Subsequent 21 Years: Findings from a Prospective Cohort Study

Callaway

McIntyre

O’Callaghan

et al. 2007

American Journal of Epidemiology

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Obesity is an important risk factor for hypertensive disorders of pregnancy, but most cases of hypertensive disorders of pregnancy occur in women of normal weight. There may be predisposing factors to both hypertensive disorders of pregnancy and obesity. To test this hypothesis, the authors compared changes in body mass index (weight (kg)/height (m) 2 ) over time in women with and without hypertensive disorders of pregnancy. They used data from 3,572 women who received antenatal care at a major public hospital in Brisbane, Australia, between 1981 and 1984 and who were followed up for 21 years. A total of 318 women (8.9%) had experienced hypertensive disorders in the index pregnancy, and 233 of them (73.3%) had a baseline body mass index of 25 kg/m 2 . After the authors adjusted for all potential confounding factors, they found that women with hypertensive disorders of pregnancy gained on average 1.35 kg/m 2 more (95% confidence interval: 0.80 kg/m 2 , 1.89 kg/m 2 ) in body mass index over 21 years than women without hypertensive disorders of pregnancy. The odds of gaining 5 kg/m 2 were 59% greater for women who experienced hypertensive disorders of pregnancy compared with those who did not (odds ratio = 1.59, 95% confidence interval: 1.24, 2.04). The authors concluded that hypertensive disorders of pregnancy are associated with increased weight gain over 21 years. body mass index; body weight; hypertension; pre-eclampsia; pregnancy; prospective studies; weight gain; women Abbreviations: BMI, body mass index; HDP, hypertensive disorders of pregnancy

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“…As pregnancy is a biological 'stress test' of sorts, women with a prior HDP (particularly associated with preterm delivery or adverse perinatal outcome) should be informed of their increased future health risks, including; hypertension; cardiovascular and cerebrovascular morbidity and mortality; subsequent renal disease; thromboembolism; hypothyroidism; and type 2 diabetes mellitus [494][495][496][497][498][499][500][501][502][503]. It is unclear whether the microalbuminuria associated with previous preeclampsia represents underlying renal disease or is an independent cardiovascular risk marker [504].…”

Section: Commentsmentioning

confidence: 99%

RETIRED: Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy

Magee

Pels

Helewa

et al. 2008

Journal of Obstetrics and Gynaecology Canada

421

218

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Research pointers: Risk of subsequent thromboembolism for patients with pre-eclampsia

Cited by 53 publications

References 6 publications

Hypertensive Pregnancy Disorders and Subsequent Cardiovascular Morbidity and Type 2 Diabetes Mellitus in the Mother

Hypertensive Pregnancy Disorders and Subsequent Cardiovascular Morbidity and Type 2 Diabetes Mellitus in the Mother

The Association of Hypertensive Disorders of Pregnancy with Weight Gain over the Subsequent 21 Years: Findings from a Prospective Cohort Study

RETIRED: Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy

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