Are hypertensive disorders of pregnancy a risk factor for developing cardiovascular disease in women

Objective:To investigate whether previously reported increasing incidence of pregnancy-associated stroke (PAS) is observed in chart-validated register data in Finland. In an exploratory analysis, we studied risk factors for PAS.Methods:We performed a retrospective population-based cohort study and nested case-control study in Finland 1987-2016. The Medical Birth Register (MBR) was linked with the Hospital Discharge Register to identify women with incident stroke (ischemic stroke, cerebral venous thrombosis, intracerebral or subarachnoid hemorrhage) during pregnancy or puerperium. Cases were verified from patient records. Incidence of PAS over the study period, in 5-year age groups and pregnancy/postpartum period were calculated per number of deliveries. Three matched controls were selected for each case from MBR to compare risk factors.Results:After chart review, 29.6% (257/868) of cases were PAS. The incidence of PAS was 14.5 (95%CI: 12.8-16.3) per 100,000 deliveries. Incidence increased from 11.1 to 25.2 per 100,000 deliveries from 1987-1991 to 2012-2016 (p<0.0001). Incidence increased by age from 9.8 to 29.9 per 100,000 deliveries from ages 20-24 to ages >40 (p<0.0001). During early postpartum period, incidence was 5-fold greater compared to the first trimester. Maternal mortality was 6.6%. In the multivariable adjusted model, smoking beyond 12 gestational weeks (odds ratio [OR] 1.8, 95%CI: 1.2-2.7), migraine (OR 16.3, 95%CI: 5.3-49.8), and hypertensive disorders of pregnancy (OR 4.0, 95%CI: 2.5-6.3) were the most important risk factors for PAS.Conclusion:PAS incidence is increasing stressing the importance of careful pregnancy surveillance and risk factor management, particularly in older expectant mothers and extending to puerperium.Classification of Evidence:This study provides Class III evidence that smoking beyond 12 gestational weeks, migraine and hypertensive disorders of pregnancy are associated with an increased risk of PAS.

Download Full-text

RETRACTED ARTICLE: Investigation of elevation as a risk factor for hypertensive disorders of pregnancy among Colorado women between 2007 and 2015

Hypertension in Pregnancy ◽

10.1080/10641955.2018.1538378 ◽

2018 ◽

Vol 38 (1) ◽

pp. 1-12 ◽

Cited By ~ 2

Author(s):

Lauren J. Heath ◽

Hailey Hyde ◽

Christin Miller ◽

Jill M. Norris

Keyword(s):

Risk Factor ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders ◽

Retracted Article

Download Full-text

Differential effects of body fatness and body fat distribution on risk factor for cardiovascular disease in women. Impact of weight loss.

Arteriosclerosis and Thrombosis A Journal of Vascular Biology ◽

10.1161/01.atv.13.10.1487 ◽

1993 ◽

Vol 13 (10) ◽

pp. 1487-1494 ◽

Cited By ~ 13

Author(s):

K E Dennis ◽

A P Goldberg

Keyword(s):

Cardiovascular Disease ◽

Weight Loss ◽

Risk Factor ◽

Body Fat ◽

Fat Distribution ◽

Body Fat Distribution ◽

Body Fatness ◽

Differential Effects ◽

Cardiovascular Disease In Women

Download Full-text

Prepregnancy adherence to dietary recommendations for the prevention of cardiovascular disease in relation to risk of hypertensive disorders of pregnancy

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqaa214 ◽

2020 ◽

Vol 112 (6) ◽

pp. 1429-1437 ◽

Cited By ~ 1

Author(s):

Mariel Arvizu ◽

Jennifer J Stuart ◽

Janet W Rich-Edwards ◽

Audrey J Gaskins ◽

Bernard Rosner ◽

...

Keyword(s):

Cardiovascular Disease ◽

General Population ◽

Gestational Hypertension ◽

Health Study ◽

Hypertensive Disorders Of Pregnancy ◽

Dietary Recommendations ◽

Cvd Risk ◽

Adherence To Diet ◽

Hypertensive Disorders ◽

Prevention Of Cardiovascular Disease

ABSTRACT Background It is unclear whether adherence to diet recommendations for the prevention of cardiovascular disease (CVD) in the general population is also related to the risk of hypertensive disorders of pregnancy, including pre-eclampsia and gestational hypertension (GHTN). Objectives The aim was to evaluate the relation of prepregnancy adherence to the American Heart Association (AHA) diet recommendations and the Dietary Approaches to Stop Hypertension (DASH) with the risk of pre-eclampsia and GHTN. Methods Between 1991 and 2009, we prospectively followed 16,892 singleton pregnancies among 11,535 women who participated in the Nurses’ Health Study II. Prepregnancy diet was assessed every 4 y, from which we calculated dietary pattern scores from the DASH diet (8 components) and the diet recommendations from the AHA 2020 Strategic Impact Goals (primary score: 5 components; secondary score: primary score plus 3 components). Pregnancy outcomes were self-reported, and we estimated the RR (95% CI) of pre-eclampsia and GHTN with log-binomial regression using generalized estimating equations to account for repeat pregnancies and adjusting for potential confounders. Results Women had a mean (SD) age of 34.4 (34.0) y at pregnancy. Pre-eclampsia was reported in 495 (2.9%) pregnancies and GHTN in 561 (3.3%) pregnancies. The RR (95% CI) of pre-eclampsia for women in the highest quintile of the DASH was 0.65 (0.48, 0.87) compared with women in the lowest score quintile. A similar inverse trend was observed for the AHA primary (0.74; 95% CI: 0.55, 1.00) and secondary (0.81; 95% CI: 0.61, 1.07) scores comparing women in the highest versus the lowest score quintile. Neither the DASH nor the AHA scores were related to GHTN. Conclusions Women with higher adherence to dietary recommendations for the prevention of CVD in the general population had a lower risk of pre-eclampsia—a common pregnancy complication related to higher CVD risk among women—than women with lower adherence to these recommendations.

Download Full-text