Effect of an Intervention to Improve the Cardiovascular Health of Postpartum Women With a History of Hypertensive Disorders of Pregnancy

ObjectivesCompare the predictive performance of Framingham Risk Score (FRS), Pooled Cohort Equations (PCEs) and Systematic COronary Risk Evaluation (SCORE) model between women with and without a history of hypertensive disorders of pregnancy (hHDP) and determine the effects of recalibration and refitting on predictive performance.MethodsWe included 29 751 women, 6302 with hHDP and 17 369 without. We assessed whether models accurately predicted observed 10-year cardiovascular disease (CVD) risk (calibration) and whether they accurately distinguished between women developing CVD during follow-up and not (discrimination), separately for women with and without hHDP. We also recalibrated (updating intercept and slope) and refitted (recalculating coefficients) the models.ResultsOriginal FRS and PCEs overpredicted 10-year CVD risks, with expected:observed (E:O) ratios ranging from 1.51 (for FRS in women with hHDP) to 2.29 (for PCEs in women without hHDP), while E:O ratios were close to 1 for SCORE. Overprediction attenuated slightly after recalibration for FRS and PCEs in both hHDP groups. Discrimination was reasonable for all models, with C-statistics ranging from 0.70-0.81 (women with hHDP) and 0.72–0.74 (women without hHDP). C-statistics improved slightly after refitting 0.71–0.83 (with hHDP) and 0.73–0.80 (without hHDP). The E:O ratio of the original PCE model was statistically significantly better in women with hHDP compared with women without hHDP.ConclusionsSCORE performed best in terms of both calibration and discrimination, while FRS and PCEs overpredicted risk in women with and without hHDP, but improved after recalibrating and refitting the models. No separate model for women with hHDP seems necessary, despite their higher baseline risk.

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Annual body mass index gain and risk of hypertensive disorders of pregnancy in a subsequent pregnancy

Scientific Reports ◽

10.1038/s41598-021-01976-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Sho Tano ◽

Tomomi Kotani ◽

Takafumi Ushida ◽

Masato Yoshihara ◽

Kenji Imai ◽

...

Keyword(s):

Body Mass Index ◽

Weight Gain ◽

Body Mass ◽

Body Weight Gain ◽

Subsequent Pregnancy ◽

The Body ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders ◽

Age Related ◽

History Of

AbstractWeight gain during interpregnancy period is related to hypertensive disorders of pregnancy (HDP). However, in interpregnancy care/counseling, the unpredictability of the timing of the next conception and the difficulties in preventing age-related body weight gain must be considered while setting weight management goals. Therefore, we suggest considering the annual change in the body mass index (BMI). This study aimed to clarify the association between annual BMI changes during the interpregnancy period and HDP risk in subsequent pregnancies. A multicenter retrospective study of data from 2009 to 2019 examined the adjusted odds ratio (aOR) of HDP in subsequent pregnancies. The aORs in several annual BMI change categories were also calculated in the subgroups classified by HDP occurrence in the index pregnancy. This study included 1,746 pregnant women. A history of HDP (aOR, 16.76; 95% confidence interval [CI], 9.62 − 29.22), and annual BMI gain (aOR, 2.30; 95% CI, 1.76 − 3.01) were independent risk factors for HDP in subsequent pregnancies. An annual BMI increase of ≥ 1.0 kg/m2/year was related to HDP development in subsequent pregnancies for women without a history of HDP. This study provides data as a basis for interpregnancy care/counseling, but further research is necessary to validate our findings and confirm this relationship.

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Left ventricular mass and myocardial scarring in women with hypertensive disorders of pregnancy

Open Heart ◽

10.1136/openhrt-2020-001273 ◽

2020 ◽

Vol 7 (2) ◽

pp. e001273

Author(s):

Odayme Quesada ◽

Ki Park ◽

Janet Wei ◽

Eileen Handberg ◽

Chrisandra Shufelt ◽

...

Keyword(s):

Vascular Dysfunction ◽

Obstructive Coronary Artery Disease ◽

Left Ventricular ◽

Hypertensive Disorders Of Pregnancy ◽

Similar Frequency ◽

Hypertensive Disorders ◽

Lv Mass ◽

Scar Size ◽

History Of ◽

And Function

AimsHypertensive disorders of pregnancy (HDP) predict future cardiovascular events. We aim to investigate relations between HDP history and subsequent hypertension (HTN), myocardial structure and function, and late gadolinium enhancement (LGE) scar.Methods and resultsWe evaluated a prospective cohort of women with suspected ischaemia with no obstructive coronary artery disease (INOCA) who underwent stress/rest cardiac magnetic resonance imaging (cMRI) with LGE in the Women’s Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction study. Self-reported history of pregnancy and HDP (gestational HTN, pre-eclampsia, toxaemia and eclampsia) were collected at enrollment. In our cohort of 346, 20% of women report a history of HDP. HDP history was associated with 3.2-fold increased odds of HTN. Women with a history of both HDP and HTN had higher cMRI measured left ventricular (LV) mass compared with women with HDP only (99.4±2.6 g vs 87.7±3.2 g, p=0.02). While we found a similar frequency of LGE scar, we observed a trend towards increased LGE scar size (5.1±3.4 g vs 8.0±3.4 g, p=0.09) among the women with HDP history compared to women without.ConclusionIn a high-risk cohort of women with suspected INOCA, 20% had a history of HDP. Women with HDP history were more likely to develop HTN. Our study demonstrates higher LV mass in women with HDP and concomitant HTN. Although the presence of LGE scar was not different in women with and without HDP history, we observed a trend towards larger scar size in women with HDP. Future studies are needed to better assess the relationship of HDP and cardiac morphology and LGE scarring in a larger cohort of women.

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Reproductive history and blood cell DNA methylation later in life: the Young Finns Study

Clinical Epigenetics ◽

10.1186/s13148-021-01215-1 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Emily W. Harville ◽

Pashupati P. Mishra ◽

Mika Kähönen ◽

Emma Raitoharju ◽

Saara Marttila ◽

...

Keyword(s):

Dna Methylation ◽

Reproductive History ◽

Hypertensive Disorders Of Pregnancy ◽

Birth Registry ◽

Hypertensive Disorders ◽

Epigenetic Age ◽

Epigenetic Age Acceleration ◽

Epigenetic Methylation ◽

History Of ◽

Young Finns Study

Abstract Background Women with a history of complications of pregnancy, including hypertensive disorders, gestational diabetes or an infant fetal growth restriction or preterm birth, are at higher risk for cardiovascular disease later in life. We aimed to examine differences in maternal DNA methylation following pregnancy complications. Methods Data on women participating in the Young Finns study (n = 836) were linked to the national birth registry. DNA methylation in whole blood was assessed using the Infinium Methylation EPIC BeadChip. Epigenome-wide analysis was conducted on differential CpG methylation at 850 K sites. Reproductive history was also modeled as a predictor of four epigenetic age indices. Results Fourteen significant differentially methylated sites were found associated with both history of pre-eclampsia and overall hypertensive disorders of pregnancy. No associations were found between reproductive history and any epigenetic age acceleration measure. Conclusions Differences in epigenetic methylation profiles could represent pre-existing risk factors, or changes that occurred as a result of experiencing these complications.

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P3463Cardiometabolic risk factors in women with a history of hypertensive disorders of pregnancy

European Heart Journal ◽

10.1093/eurheartj/ehz745.0336 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

V Chulkov ◽

O Tarasova ◽

N Vereina ◽

V L Chulkov ◽

S Sinitsin

Keyword(s):

Risk Factors ◽

Plasma Levels ◽

Cardiometabolic Risk ◽

Left Ventricular ◽

Careful Examination ◽

Time Interval ◽

Hypertensive Disorders Of Pregnancy ◽

The Metabolic Syndrome ◽

Hypertensive Disorders ◽

History Of

Abstract Introduction A history of hypertensive disorders of pregnancy (HDP) has the unique potential to identify women at higher risk of future maternal cardiovascular disease (CVD), for whom targeted risk-reduction interventions may be particularly helpful. Purpose The aim of the study was to assess the factors and biomarkers of cardiometabolic risk in women with a history of hypertensive disorders of pregnancy. Methods Cross-sectional study of risk factors and biomarkers of cardiometabolic risk among young women with a history of HDP in comparison with normotensive patients during pregnancy. 117 women were studied: gr. 1 – 33 with a history of HDP, 40 [40–43] years; gr. 2 – 44 without a history of HDP, 39 [32–43] years. The control group consisted of 40 patients, 25 [23–28] years. The time interval after delivery was on average 5 to 19 years. We measured serum glucose, insulin, HOMA-IR, lipids, leptin, adiponectin. Left ventricular mass index (LVMI) was estimated by TTE. Data are presented as M±SD and Me (Q25–Q75). Results Women with HDP more often had hypertension (n=27; 82%), obesity (n=20; 39%) and smoking (n=9; 27%), p1–2,3 <0.05. A higher plasma levels of glucose mmol/L (5.5±0.7 vs 5.2±0.6 and 5.1±0.5), leptin ng/ml (42 [30–50] vs 24 [13–32] and 19 [10–29]) and lower plasma levels of adiponectin were observed in gr.1 vs gr. 2 and controls. Mean value of LVMI (g/m2) was statistically higher in women with HDP vs. without HDP and controls (119.9±23.7 vs 85.9±15.2 and 77.6±11.3), p1–2,3 <0.05. Conclusion It is shown that in women with a history of HDP subsequent changes in carbohydrate and lipid metabolism in combination with arterial hypertension and abdominal obesity, which constitute a cluster of the metabolic syndrome, are revealed after careful examination. These changes are also accompanied by insulin resistance, hyperinsulinemia, adipokine imbalance and more pronounced target organ damage.

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Hypertensive Disorders of Pregnancy and Future Cardiovascular Health

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2020.00059 ◽

2020 ◽

Vol 7 ◽

Cited By ~ 5

Author(s):

Karen Melchiorre ◽

Basky Thilaganathan ◽

Veronica Giorgione ◽

Anna Ridder ◽

Alessia Memmo ◽

...

Keyword(s):

Cardiovascular Health ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders

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Assessing knowledge of healthcare providers concerning cardiovascular risk after hypertensive disorders of pregnancy: an Australian national survey

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03418-5 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Heike Roth ◽

Caroline S. E. Homer ◽

Clare Arnott ◽

Lynne Roberts ◽

Mark Brown ◽

...

Keyword(s):

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Cardiovascular Health ◽

Gestational Hypertension ◽

Current Knowledge ◽

Healthcare Providers ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders ◽

Increased Risk

Abstract Background Hypertensive disorders of pregnancy (HDP) affect 5–10% of pregnant women. Women after HDP have 2–3 times increased risk of heart attack, stroke and diabetes, as soon as 5–10 years after pregnancy. Australian healthcare providers’ knowledge of cardiovascular disease (CVD) risks for women after HDP is unknown, and this study aimed to explore their current knowledge and practice regarding long-term cardiovascular health after HDP, as a precursor to producing targeted healthcare provider education on health after HDP. Methods A custom-created, face-validated online survey explored knowledge about long-term risks after HDP. Distribution occurred from February to July 2019 via professional colleges, key organisations and social media. The objective was to assess current knowledge and knowledge gaps amongst a group of healthcare providers (HCP) in Australia, regarding long-term cardiovascular health after hypertensive disorders of pregnancy (HDP), specifically gestational hypertension or preeclampsia. Results Of 492 respondents, 203 were midwives, 188 obstetricians, 75 general practitioners (GP), and 26 cardiologists. A risk knowledge score was computed with 0–6 considered low, 6.1–8.9 moderate and 9–12 high. Most participants (85%) were aware of increased cardiovascular disease after preeclampsia and gestational hypertension (range 76% midwives to 100% cardiologists). There were significant differences in average knowledge scores regarding health after preeclampsia; high for cardiologists (9.3), moderate for GPs and obstetricians (8.2 and 7.6 respectively) and low for midwives (5.9). Average knowledge scores were somewhat lower for gestational hypertension (9.0 for cardiologists, 7.4 for obstetricians and GPs, 5.1 for midwives). Knowledge was highest regarding risk of chronic hypertension, moderate to high regarding risk of ischaemic heart disease, stroke and recurring HDP, and low for diabetes and peripheral vascular disease. Only 34% were aware that risks start < 10 years after the affected pregnancy. Conclusion(s) Participants were aware there is increased cardiovascular risk after HDP, although less aware of risks after gestational hypertension and some specific risks including diabetes. Findings will inform the development of targeted education.

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Intakes of Major Types of Fat Before Pregnancy and Hypertensive Disorders of Pregnancy

Current Developments in Nutrition ◽

10.1093/cdn/nzaa054_008 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 936-936

Author(s):

Mariel Arvizu ◽

Audrey Gaskins ◽

Jennifer Stuart ◽

Janet Rich-Edwards ◽

Jorge E Chavarro

Keyword(s):

Health Study ◽

Fat Intake ◽

Trans Fat ◽

Hypertensive Disorders Of Pregnancy ◽

Trans Fats ◽

Funding Sources ◽

Hypertensive Disorders ◽

History Of ◽

Total Fat ◽

Risk Of Preeclampsia

Abstract Objectives While there is significant literature on the relation between intake of fat and of specific fatty acids during pregnancy with the risk of preeclampsia, the relation of pre-pregnancy intake with preeclampsia and GHTN has not been extensively evaluated. Methods In the Nurses’ Health Study II, 11,660 women without a history of chronic disease reported 17,114 singleton pregnancies between 1992 and 2009. Pre-pregnancy diet was assessed every four years, starting in 1991 using a 131-item food frequency questionnaire. GHTN and preeclampsia were self-reported biennially. The relative risk (RR) and 95% confidence intervals (CI) of GHTN and preeclampsia were estimated with log-binomial regression, employing generalized estimating equations to account for repeated pregnancies, and adjusting for total energy intake, protein intake, age at pregnancy, marital status, history of infertility, gestational diabetes, parity, multivitamin use, race, and co-adjustment for major types of fat. Results Mean (SD) age at pregnancy was 34.6 (3.9) years. Hypertensive disorders of pregnancy (HDP) were reported in 1066 (6%) pregnancies (564 [3%] GHTN; 502 [3%] preeclampsia). Total fat intake before pregnancy was not associated with the risk of GHTN or preeclampsia. When intakes of major types of fats (saturated, monounsaturated, polyunsaturated, and trans) were evaluated, only intake of trans fats was associated with a higher risk of preeclampsia. Women in the highest quartile of trans fat intake (median [range], 2.18 [1.84–5.75] % of calories) had a 45% (CI: 7%, 97%; p-trend = 0.01) greater risk of preeclampsia than women with the lowest quartile of intake (median [range]: 0.91 [0.11–1.09] % of calories). A similar, albeit attenuated, association was observed with trans fat intake and GHTN (p-trend = 0.12). Intakes of major types of fat were unrelated to GHTN. Conclusions Greater intake of trans fats before pregnancy was associated with a higher risk of preeclampsia, but not GHTN. However, the extent to which these findings are generalizable to current intake levels in the general US population remains to be determined. Intakes of all other major fat types were unrelated to the risk of HDP. Funding Sources Supported by National Institutes of Health grants UM1-CA176726, P30-DK046200, R00ES026648, U54-CA155626, and T32-DK007703–16.

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