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Incidence and Long-Term Outcomes of Hypertensive Disorders of Pregnancy
Open accessAbstract
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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“Hypertensive disorders of pregnancy (HDP) is one of the leading causes of maternal and fetal morbidity and mortality worldwide and potentially a critical threat to maternal and infant health [1].”
From Epidemiological trends of maternal hypertensive disorders of pregnancy at the global, regional, and national levels: a population‐based study (2021) · cites this paper as [1]
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Garovic, V. D., Dechend, R., Easterling, T., Karumanchi, S. A., McMurtry Baird, S., Magee, L. A., Rana, S., Vermunt, J. V., August, P., & on behalf of the American Heart Association Council on Hypertension; Council on the Kidney in Cardiovascular Disease, K. I. H. D. S. C. C. O. A. (2022) · Hypertension · doi:10.1161/hyp.0000000000000208 · Cited by 598
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Pregnancy and Reproductive Risk Factors for Cardiovascular Disease in Women
O’Kelly, A. C., Michos, E. D., SHUFELT, C. L., Vermunt, J. V., Minissian, M., Quesada, O., Smith, G. N., Rich-Edwards, J. W., Garovic, V. D., Khoudary, S. R. E., et al. (2022) · Circulation Research · doi:10.1161/circresaha.121.319895 · Cited by 358
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Metadata
- 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)
- 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
- bronze
- doi.org
- 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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