BACKGROUND AND PURPOSE:

• There is data that indicate a twofold to fourfold increase in post-pregnancy risk of hypertension in women who have hypertensive disorders during pregnancy
• The timing of onset of post-pregnancy hypertension is not well known
• Behrens et al. (BMJ, 2017) sought to determine the timing of post-pregnancy hypertension in women who had hypertensive disorders in pregnancy

METHODS:

• Nationwide register based cohort study
• 482,972 primiparous women with a first live birth or still birth between 1995-2012 and 1,025,118 women with at least one live birth or still birth between 1978- 2012
• Hypertensive disorder was defined as one of the following diagnoses any time between one month before delivery and seven days postpartum
  • Gestational hypertension
  • Pre-eclampsia
  • Eclampsia
  • HELLP syndrome
• Pregestational hypertension was excluded and defined as antihypertensive drug use before their first pregnancy or up to 20 weeks’ gestation in that first pregnancy
• Outcomes included a 10 year cumulative incidences of post-pregnancy hypertension requiring treatment with prescription drugs

RESULTS:

• Women in their 20s with hypertensive disorders of pregnancy had higher risk of hypertension in the first decade postpartum, compared to normotensive women (14% versus 4%)
• Women in their 40s showed the same trend if hypertensive in their first pregnancies (32% versus 11%)
• 1 year following delivery, women with a hypertensive disorder of pregnancy had 12—fold to 25-fold higher rates of hypertension
• 1-10 years following delivery, women with a hypertensive disorder of pregnancy had 3- to 10- fold higher rates of hypertension
• 20 or more years later, hypertension rates remained twice as high
• Two hypertensive pregnancies increased the risks of hypertension than women with one affected pregnancy
• Among women with a hypertensive disorder of pregnancy in only one of two pregnancies, a hypertensive disorder of pregnancy in the second pregnancy was more strongly associated with later hypertension

CONCLUSION:

• Hypertension risk associated with hypertensive disorders of pregnancy is high immediately after pregnancy and persists for more than 20 years
• The authors recommend cardiovascular disease prevention with regular blood pressure monitoring initiated soon after a pregnancy complicated by a hypertensive disorder
  • Underlying mechanisms not well understood, but appears to be a process that starts early in life
• RCTs and research for predictive biomarkers necessary to determine best follow up protocols

Learn More – Primary Sources:

Risk of post-pregnancy hypertension in women with a history of hypertensive disorders of pregnancy: nationwide cohort study

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