Women who have 2 pregnancies complicated by preeclampsia are at a higher risk for hypertension after pregnancy, which is independent of the risk for subsequent type 2 diabetes mellitus, according to the results of a registry-based cohort study reported in the June issue of Hypertension.
"Minimal data exist concerning the relationship between hypertensive pregnancy disorders and various subsequent cardiovascular events and the effect of type 2 diabetes mellitus on these," write Jacob A. Lykke, MD, from Rigshospitalet in Copenhagen, Denmark, and colleagues. "We have designed a study using the Danish National Registries investigating the association among the following: (1) hypertensive pregnancy disorders in a first pregnancy and later cardiovascular morbidity and type 2 diabetes mellitus; (2) combinations of (mild and severe) preeclampsia, preterm delivery, and small for gestational age (SGA) offspring in a first pregnancy and later cardiovascular morbidity and type 2 diabetes mellitus; (3) the parity and recurrence of preeclampsia (mild and severe) in the second pregnancy and later cardiovascular morbidity and type 2 diabetes mellitus; and (4) the contribution of type 2 diabetes mellitus to the above associations."
The study cohort consisted of 782,287 women delivering in Denmark from 1978 to 2007 with a first singleton pregnancy and 536,419 women with 2 first consecutive singleton deliveries. Relevant exposures were gestational hypertension and mild and severe preeclampsia, and the study outcomes were subsequent hypertension, ischemic heart disease, congestive heart failure, thromboembolic event, stroke, and type 2 diabetes mellitus. In 1 model, the investigators adjusted for preterm delivery, small for gestational age, placental abruption, and stillbirth, and in a second model, they also adjusted for the development of type 2 diabetes mellitus.
After gestational hypertension, the risk for subsequent hypertension was increased 5.31-fold (range, 4.90 - 5.75) vs 3.61-fold (range, 3.43 - 3.80) after mild preeclampsia and 6.07-fold (range, 5.45 - 6.77) after severe preeclampsia. Increased risks for subsequent type 2 diabetes mellitus were 3.12-fold (range, 2.63 - 3.70) after gestational hypertension and 3.68-fold (range, 3.04 - 4.46) after severe preeclampsia.
For women having 2 pregnancies with preeclampsia, the risk for subsequent hypertension was increased 6.00-fold (range, 5.40 - 6.67) vs 2.70-fold (range, 2.51 - 2.90) for preeclampsia in the first pregnancy only and 4.34-fold (range, 3.98 - 4.74) for preeclampsia in the second pregnancy only. After gestational hypertension, the risk for subsequent thromboembolism was 1.03-fold (range, 0.73 - 1.45) vs 1.53-fold (range, 1.32 - 1.77) for mild preeclampsia and 1.91-fold (range, 1.35 - 2.70) for severe preeclampsia.
"Hypertensive pregnancy disorders are strongly associated with subsequent type 2 diabetes mellitus and hypertension, the latter independent of subsequent type 2 diabetes mellitus," the study authors write. "The severity, parity, and recurrence of these hypertensive pregnancy disorders increase the risk of subsequent cardiovascular events....Physicians and other health care professionals should be encouraged to include the history of a woman's pregnancy outcomes when estimating the risk of cardiovascular disease."
Limitations of this study include low sensitivities for hypertensive diagnoses; potentially low accuracy of the endpoints; possible failure to report dyslipidemia and other factors of a metabolic syndrome; and inability to control for body mass index, smoking, or socioeconomic status.
"Because hypertensive pregnancy disorders are strongly linked with subsequent cardiovascular morbidity, especially hypertension and type 2 diabetes mellitus, both being essential components of the metabolic syndrome, a possible direct link may exist between these disorders," the study authors conclude. "Also, the severity of the hypertensive disorders seems to predispose to thromboembolic events; this also merits caution when prescribing oral contraceptives for these women. Identifying these women early will allow for prompt intervention, either primarily as modification of other classical cardiovascular risk factors or secondarily as medical prophylaxis."
Source: Medscape http://www.medscape.com/viewarticle/706565
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