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Hypertensive Disorders in Pregnancy and Subsequently Measured Cardiovascular Risk Factors

Magnussen, Elisabeth B. MD1,3; Vatten, Lars J. MD, PhD1; Smith, George Davey MD, PhD2; Romundstad, Pål R. PhD1

doi: 10.1097/AOG.0b013e3181bb0dfc
Original Research

OBJECTIVE: To study the association of hypertensive pregnancy disorders with modifiable risk factors for cardiovascular and metabolic diseases and to estimate the feasibility for early detection and prevention.

METHODS: This was a prospective study of 15,065 women with a first singleton birth between 1967 and 1995, who later participated in a population study that included standardized measurements of blood pressure, serum lipids, and body mass index (BMI).

RESULTS: Women with a history of hypertensive disorders in pregnancy (preeclampsia or gestational hypertension) had higher BMI, higher blood pressure, and unfavorable levels of total cholesterol, low-density lipoprotein cholesterol, and triglycerides. Preeclampsia was associated with substantially higher risk of developing diabetes (odds ratio 3.8, 95% confidence interval [CI] 2.1–6.6), and if the hypertensive disorder occurred in more than one pregnancy, or in a relatively late pregnancy, the associations with later cardiovascular risk factors were substantially stronger. Thus, women with two episodes of preeclampsia were approximately 10 times more likely to use blood pressure medication at follow-up (adjusted odds ratio, 11.6, 95% CI 7.1–26.3), and in women with gestational hypertension in three consecutive pregnancies, systolic pressure was on average 27 mm Hg (95% CI 18–37 mm Hg) higher, and diastolic pressure was 12 mm Hg (95% CI 5–19 mm Hg) higher, compared with women without a history of hypertensive disorders. Adjustment for current body mass index partly attenuated these associations, suggesting that BMI may play an important mediating role.

CONCLUSION: Women with a history of hypertensive disorders in pregnancy, and particularly women with recurrent pregnancy disorders, should be candidates for intervention intended to prevent premature cardiovascular disease.

LEVEL OF EVIDENCE: II

A history of recurrent hypertensive disorders in pregnancy is associated with later obesity, an unfavorable lipid profile, and elevated blood pressure. SUPPLEMENTAL DIGITAL CONTENT AVAILABLE ONLINE IN THE TEXT.

From the Departments of 1Public Health, Norwegian University of Science and Technology, Trondheim, Norway; 2Social Medicine, University of Bristol, Bristol, United Kingdom; and 3Obstetrics and Gynecology, St. Olavs University Hospital, Trondheim, Norway.

See related editorial on page 958.

Supported by the Norwegian University of Science and Technology.

The Nord-Trøndelag Health (HUNT) study is a collaborative effort of the Faculty of Medicine, The University of Science and Technology, The Norwegian Institute of Public Health, and the Nord-Trøndelag County Council.

For supplementary tables showing characteristics of pregnancies, estimated mean diastolic blood pressure, and use of blood pressure medication at follow-up according to hypertensive disorders in earlier pregnancies, see the Appendix online at http://links.lww.com/AOG/A124.

Corresponding author: Pål Richard Romundstad, Department of Public Health, NTNU, N-7489 Trondheim, Norway; e-mail: paalr@ntnu.no.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2009 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.