Association of Adverse Pregnancy Outcomes With Hypertension 2 to 7 Years Postpartum

for the NHLBI nuMoM2b Heart Health Study

Research output: Contribution to journalArticlepeer-review

89 Scopus citations

Abstract

Background: Identifying pregnancy-associated risk factors before the development of major cardiovascular disease events could provide opportunities for prevention. The objective of this study was to determine the association between outcomes in first pregnancies and subsequent cardiovascular health. Methods and Results: The Nulliparous Pregnancy Outcomes Study Monitoring Mothers-to-be Heart Health Study is a prospective observational cohort that followed 4484 women 2 to 7 years (mean 3.2 years) after their first pregnancy. Adverse pregnancy outcomes (defined as hypertensive disorders of pregnancy, small-for-gestational-age birth, preterm birth, and stillbirth) were identified prospectively in 1017 of the women (22.7%) during this pregnancy. The primary outcome was incident hypertension (HTN). Women without adverse pregnancy outcomes served as controls. Risk ratios (RR) and 95% CIs were adjusted for age, smoking, body mass index, insurance type, and race/ethnicity at enrollment during pregnancy. The overall incidence of HTN was 5.4% (95% CI 4.7% to 6.1%). Women with adverse pregnancy outcomes had higher adjusted risk of HTN at follow-up compared with controls (RR 2.4, 95% CI 1.8-3.1). The association held for individual adverse pregnancy outcomes: any hypertensive disorders of pregnancy (RR 2.7, 95% CI 2.0-3.6), preeclampsia (RR 2.8, 95% CI 2.0-4.0), and preterm birth (RR 2.7, 95% CI 1.9-3.8). Women who had an indicated preterm birth and hypertensive disorders of pregnancy had the highest risk of HTN (RR 4.3, 95% CI 2.7-6.7). Conclusions: Several pregnancy complications in the first pregnancy are associated with development of HTN 2 to 7 years later. Preventive care for women should include a detailed pregnancy history to aid in counseling about HTN risk. Clinical Trial Registration: URL: http://www.clinicaltrials.gov Unique identifier: NCT02231398.

Original languageEnglish (US)
Article numbere013092
JournalJournal of the American Heart Association
Volume8
Issue number19
DOIs
StatePublished - Oct 1 2019

Funding

This study is supported by cooperative agreement funding from the National Heart, Lung, and Blood Institute and the Eunice Kennedy Shriver National Institute of Child Health and Human Development: U10‐HL119991; U10‐HL119989; U10‐HL120034; U10‐HL119990; U10‐HL120006; U10‐HL119992; U10‐HL120019; U10‐HL119993; and U10‐HL120018. Support was also provided by the National Institutes of Health: Office of Research on Women's Health through U10‐HL‐119991; Office of Behavioral and Social Sciences Research through U10‐HL119991 and U10‐HL119992; and the National Center for Advancing Translational Sciences through UL‐1‐TR000124, UL‐1‐TR000153, UL‐1‐TR000439, and UL‐1‐TR001108; and the Barbra Streisand Women's Cardiovascular Research and Education Program, and the Erika J. Glazer Women's Heart Research Initiative, Cedars‐Sinai Medical Center, Los Angeles. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This study is supported by cooperative agreement funding from the National Heart, Lung, and Blood Institute and the Eunice Kennedy Shriver National Institute of Child Health and Human Development: U10-HL119991; U10-HL119989; U10-HL120034; U10-HL119990; U10-HL120006; U10-HL119992; U10-HL120019; U10-HL119993; and U10-HL120018. Support was also provided by the National Institutes of Health: Office of Research on Women's Health through U10-HL-119991; Office of Behavioral and Social Sciences Research through U10-HL119991 and U10-HL119992; and the National Center for Advancing Translational Sciences through UL-1-TR000124, UL-1-TR000153, UL-1-TR000439, and UL-1-TR001108; and the Barbra Streisand Women's Cardiovascular Research and Education Program, and the Erika J. Glazer Women's Heart Research Initiative, Cedars-Sinai Medical Center, Los Angeles. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Keywords

  • adverse pregnancy outcomes
  • hypertension
  • preeclampsia
  • preterm birth
  • risk

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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