Hypertension during pregnancy may signal future cardiac risk | Am J Obstet Gynecol

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Take Away
  • Women with a history of hypertension during pregnancy have a higher mortality rate from cardiovascular disease compared to women who are normotensive during pregnancy.
Study Design
  • Women who delivered at Royal Prince Alfred Women and Babies, Sydney Austrailia, between 1980 and 1989 provided the pregnancy cohort.
  • A sub cohort of these women included those who were coded as having hypertension during pregnancy and a separate cohort that remained normotensive throughout pregnancy.
  • The entire cohort was then linked to health registries (New South Wales Births, Deaths, Marriages Registry and the Australian Bureau Statistics Death Registry; linkage dates 1980-2009).
  • Cardiovascular deaths were identified using ICD codes.
Key Results
  • 14% of this population were identified as having hypertension in pregnancy.
  • Women with hypertension during pregnancy had a greater risk of death from cardiovascular disease than those who were normotensive during pregnancy (OR 1.56 CI 95% 1.28-1.89 p<0.001).
  • More than one pregnancy affected by hypertension or the diagnosis of preeclampsia increased the risk of death from cardiovascular disease.
Limitations
  • Pathophysiology of vascular damage during a hypertensive pregnancy not discussed.
  • No clear recommendations for screening women with a history of hypertension in pregnancy currently exist.
  • Retrospective study.
  • Some of the cohort may not have been diagnosed with cardiovascular disease due to time frame used.
Why This Matters
  • Increased surveillance of women with a history of hypertension during pregnancy may help to reduce mortality from cardiovascular disease.
  • Review of pregnancy history should be an important part of a woman's routine health maintenance.