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Grand Rounds

Does Hypertension in Pregnancy Predict Hypertension Later in Life?

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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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Related ObG Topics:

Diagnosing Preeclampsia – Key Definitions and ACOG Guidelines
Does Exercise During Pregnancy Impact Hypertension or Macrosomia?
Aspirin Treatment for Women at Risk for Preeclampsia – ACOG, SMFM and USPSTF Recommendations
ASPRE Trial: A Combined Risk Algorithm and Use of Aspirin to Prevent Preterm Preeclampsia
Deliver Low Risk Patients at 39 Weeks to Prevent Hypertensive Complications?

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