The following is a summary of “Association between hypertensive disorders of pregnancy and cardiovascular diseases within 24 months after delivery,” published in the JULY 2023 issue of Obstetrics and Gynecology by Ackerman-Banks, et al.
For a longitudinal population-based study, researchers sought to assess the risk of specific cardiovascular diagnoses during the first 24 months after delivery in patients with hypertensive disorders of pregnancy compared to those without such disorders.
The study included pregnant individuals with deliveries between 2007 and 2019, using data from the Maine Health Data Organization’s All Payer Claims Data. Patients with preexisting cardiovascular disease, multifetal pregnancies, or without continuous insurance during pregnancy were excluded. Hypertensive disorders of pregnancy and cardiovascular diseases were identified using diagnosis codes. Hazard ratios were estimated using Cox proportional hazards models, adjusting for potential confounding factors.
Out of the 119,422 pregnancies analyzed, the risk of cardiovascular disease within 24 months after delivery differed significantly between patients with hypertensive disorders of pregnancy and those without such disorders. The cumulative risk of specific cardiovascular diseases for patients with hypertensive disorders of pregnancy compared to those without were as follows: heart failure (0.6% vs. 0.2%), ischemic heart disease (0.3% vs. 0.1%), arrhythmia or cardiac arrest (0.2% vs. 0.2%), cardiomyopathy (0.6% vs. 0.2%), cerebrovascular disease or stroke (0.8% vs. 0.4%), severe cardiac disease (1.6% vs. 0.7%), and new chronic hypertension (9.7% vs. 1.5%). After adjusting for potential confounding factors, patients with hypertensive disorders of pregnancy had a higher risk of heart failure (adjusted hazard ratio, 2.81; 95% CI, 1.90–4.15), cerebrovascular disease (adjusted hazard ratio, 1.43; 95% CI, 1.07–1.91), cardiomyopathy (adjusted hazard ratio, 2.90; 95% CI, 1.96–4.27), and severe cardiac disease (adjusted hazard ratio, 1.90; 95% CI, 1.54–2.30) within the first 24 months after delivery compared to those without hypertensive disorders of pregnancy. Additionally, patients with hypertensive disorders of pregnancy had an increased risk of new chronic hypertension diagnosed after 42 days following delivery (adjusted hazard ratio, 7.29; 95% CI, 6.57–8.09). However, there was no significant association between hypertensive disorders of pregnancy and ischemic heart disease (adjusted hazard ratio, 0.92; 95% CI, 0.55–1.54) or cardiac arrest or arrhythmia (adjusted hazard ratio, 0.90; 95% CI, 0.52–1.57). Notably, among pregnant women with hypertensive diseases, the first diagnoses of cardiomyopathy (44%), heart failure (39%), cerebrovascular disease or stroke (39%), and severe cardiac disease (41%) all occurred in the first month following delivery.
Within 24 months of giving birth, patients with hypertensive disorders of pregnancy run a higher risk of acquiring new forms of chronic hypertension, heart failure, cerebrovascular illness, and cardiomyopathy. However, there was no significant association with ischemic heart disease, cardiac arrest, or arrhythmia. To enhance mother and newborn outcomes in subsequent pregnancies and protect long-term health, the findings emphasized the significance of focused early postpartum therapies and intensified surveillance in the first 24 months following delivery for individuals with hypertensive disorders of pregnancy.
Source: ajog.org/article/S0002-9378(23)00236-3/fulltext