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Cited by 426Pregnancy and preeclampsia studiesNeurological Complications and SyndromesGestational Diabetes Research and Management

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Incidence and Long-Term Outcomes of Hypertensive Disorders of Pregnancy

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Garovic, Vesna D., White, Wendy M., Vaughan, Lisa, Saiki, Mie, Parashuram, Santosh, Garcia-Valencia, Oscar, Weissgerber, Tracey L., Milic, Natasa, Weaver, Amy, Mielke, Michelle M.·2020·Journal of the American College of Cardiology
DOI 10.1016/j.jacc.2020.03.028PMC PMC7213062
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Abstract

Background Hypertensive disorders of pregnancy (HDP) are associated with increased risks for cardiovascular disease later in life. The HDP incidence is commonly assessed using diagnostic codes, which are not reliable; and typically are expressed per-pregnancy, which may underestimate the number of women with an HDP history after their reproductive years.Objectives This study sought to determine the incidence of HDP expressed as both per-pregnancy and per-woman, and to establish their associations with future chronic conditions and multimorbidity, a measure of accelerated aging, in a population-based cohort study.Methods Using the Rochester Epidemiology Project medical record-linkage system, the authors identified residents of Olmsted County, Minnesota, who delivered between 1976 and 1982. The authors classified pregnancies into normotensive, gestational hypertension, pre-eclampsia, eclampsia, pre-eclampsia superimposed on chronic hypertension, and chronic hypertension using a validated electronic algorithm, and calculated the incidence of HDP both per-pregnancy and per-woman. The risk of chronic conditions between women with versus those without a history of HDP (age and parity 1:2 matched) was quantified using the hazard ratio and corresponding 95% confidence interval estimated from a Cox model.Results Among 9,862 pregnancies, we identified 719 (7.3%) with HDP and 324 (3.3%) with pre-eclampsia. The incidence of HDP and pre-eclampsia doubled when assessed on a per-woman basis: 15.3% (281 of 1,839) and 7.5% (138 of 1,839), respectively. Women with a history of HDP were at increased risk for subsequent diagnoses of stroke (hazard ratio [HR]: 2.27; 95% confidence interval [CI]: 1.37 to 3.76), coronary artery disease (HR: 1.89; 95% CI: 1.26 to 2.82), cardiac arrhythmias (HR: 1.62; 95% CI: 1.28 to 2.05), chronic kidney disease (HR: 2.41; 95% CI: 1.54 to 3.78), and multimorbidity (HR: 1.25; 95% CI: 1.15 to 1.35).Conclusions The HDP population-based incidence expressed per-pregnancy underestimates the number of women affected by this condition during their reproductive years. A history of HDP confers significant increase in risks for future chronic conditions and multimorbidity.

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Authors
Garovic, V. D., White, W. M., Vaughan, L., Saiki, M., Parashuram, S., Garcia-Valencia, O., Weissgerber, T. L., Milic, N., Weaver, A., & Mielke, M. M.
Affiliations
Mayo Clinic (US)
Corresponding author
Garovic, Vesna D.
ORCID
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
2020-05
Volume
75
Issue
18
Pages
2323-2334
ISSN
0735-1097 (ISSN-L)
DOI
10.1016/j.jacc.2020.03.028
PMC
PMC7213062
OpenAlex
W3023152535
Cited by
426
References
42
Citations by year
2026: 69 · 2025: 72 · 2024: 80 · 2023: 73 · 2022: 64 · 2021: 54 · 2020: 13
FWCI
31.20
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the American College of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institutes of Health
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
  • Health Sciences › Medicine › Clinical Neurology › Neurological Complications and Syndromes
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
Keywords
hypertensive disorders of pregnancy, preeclampsia, gestational hypertension, chronic hypertension, long-term cardiovascular risk, multimorbidity, accelerated aging, stroke, coronary artery disease, cardiac arrhythmias, chronic kidney disease, Rochester Epidemiology Project, Rochester, Minnesota, women's health, Olmsted County
MeSH terms
Adult, Cardiovascular Diseases, Female, Follow-Up Studies, Humans, Kidney Diseases, Metabolic Diseases, Pregnancy, Risk Factors, Time Factors, Cohort Studies, Comorbidity, Incidence, Treatment Outcome, Hypertension, Pregnancy-Induced, Young Adult

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