Hypertensive pregnancy complications and maternal characteristics as predictors of cardiovascular health within ten years after delivery

Anni Kivelä; Seppo Heinonen; Katja Kivinen; Juha Kere; Eero Kajantie; Tiina Jääskeläinen; Hannele Laivuori; FINNPEC Study Group

doi:10.1016/j.preghy.2023.09.001

Hypertensive pregnancy complications and maternal characteristics as predictors of cardiovascular health within ten years after delivery

Pregnancy Hypertens. 2023 Dec:34:5-12. doi: 10.1016/j.preghy.2023.09.001. Epub 2023 Sep 12.

Authors

Anni Kivelä¹, Seppo Heinonen², Katja Kivinen³, Juha Kere⁴, Eero Kajantie⁵, Tiina Jääskeläinen⁶, Hannele Laivuori⁷; FINNPEC Study Group

Affiliations

¹ Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Electronic address: anni.kivela@helsinki.fi.
² Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
³ DeepScan Diagnostics Oy, Helsinki, Finland.
⁴ Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden; Stem Cells and Metabolism Research Program, University of Helsinki and Folkhälsan Research Center, Helsinki, Finland.
⁵ Clinical Medicine Research Unit, MRC, Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Population Health Unit, Finnish Institute for Health and Welfare, Helsinki and Oulu, Finland and Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
⁶ Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Food and Nutrition, University of Helsinki, Helsinki, Finland.
⁷ Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Center for Child, Adolescent, and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland; Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

PMID: 37708664
DOI: 10.1016/j.preghy.2023.09.001

Abstract

Objective: To identify the combination of maternal characteristics in women with hypertensive disorders of pregnancy (HDP) associated with hypertensive and other cardiovascular diseases (CVDs) within ten years following delivery. The aim is to understand who should receive the most intensive primary cardiovascular disease prevention.

Study design: A prospective cohort study.

Main outcome: The population was the FINNPEC cohort (2008-2011), including women with (n = 1837) and without (n = 847) HDP. The main exposures were maternal hypertensive pregnancy complications linked with maternal pregnancy data from hospital records. The outcomes were hypertensive diseases and other CVDs (International Classification of Diseases, Tenth Revision).

Results: Women with de novo pre-eclampsia (PE) had an elevated risk for hypertensive diseases within ten years following delivery. The risk of CVD was increased in women with superimposed PE and chronic hypertension (CHT) only. Women with de novo PE and hypertensive diseases were more often primiparous (41.4% vs. 23.0%, p = 0.020), had gestational diabetes (GDM) (31.0% vs. 11.7%, p = 0.002), and higher pre-pregnancy body mass index (BMI) (28.7 ± 5.8 vs. 24.6 ± 4.8 kg/m², p = 0.001), compared with women who remained normotensive. Women with superimposed PE with CVD had more likely early-onset PE, preterm delivery and were older than women without later CVD.

Conclusions: Healthcare professionals should target early prevention of CVDs in women with chronic hypertension during pregnancy; of those who developed superimposed PE prior to 34th weeks of gestation and who delivered preterm. Women with de novo PE who are overweight/obese, primiparous, and with concurrent GDM need regular blood pressure monitoring.

Keywords: Cardiovascular diseases; Chronic hypertension; Epidemiology; Gestational hypertension; Pre-eclampsia; Superimposed pre-eclampsia.

MeSH terms

Cardiovascular Diseases* / epidemiology
Cardiovascular Diseases* / etiology
Diabetes, Gestational*
Female
Humans
Hypertension* / epidemiology
Hypertension, Pregnancy-Induced* / epidemiology
Infant, Newborn
Pre-Eclampsia*
Pregnancy
Pregnancy Complications*
Prospective Studies