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

NHLBI nuMoM2b Heart Health Study

Research output: Contribution to journalArticle

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)
Pages (from-to)e013092
JournalJournal of the American Heart Association
Volume8
Issue number19
DOIs
StatePublished - Oct 1 2019

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Pregnancy Outcome
Postpartum Period
Hypertension
Pregnancy
Odds Ratio
Premature Birth
High-Risk Pregnancy
Reproductive History
Preventive Medicine
Stillbirth
Pregnancy Complications
Health
Pre-Eclampsia
Insurance
Gestational Age
Counseling
Body Mass Index
Cardiovascular Diseases
Smoking
Mothers

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Association of Adverse Pregnancy Outcomes With Hypertension 2 to 7 Years Postpartum. / NHLBI nuMoM2b Heart Health Study.

In: Journal of the American Heart Association, Vol. 8, No. 19, 01.10.2019, p. e013092.

Research output: Contribution to journalArticle

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title = "Association of Adverse Pregnancy Outcomes With Hypertension 2 to 7 Years Postpartum",
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.",
keywords = "adverse pregnancy outcomes, hypertension, preeclampsia, preterm birth, risk",
author = "{NHLBI nuMoM2b Heart Health Study} and Haas, {David M.} and Parker, {Corette B.} and Marsh, {Derek J.} and Grobman, {William A.} and Ehrenthal, {Deborah B.} and Philip Greenland and {Bairey Merz}, {C. Noel} and Pemberton, {Victoria L.} and Silver, {Robert M.} and Shannon Barnes and McNeil, {Rebecca B.} and Kirsten Cleary and Reddy, {Uma M.} and Chung, {Judith H.} and Samuel Parry and Theilen, {Lauren H.} and Blumenthal, {Elizabeth A.} and Levine, {Lisa D.} and Mercer, {Brian M.} and Hyagriv Simhan and Polito, {Lu Ann} and Wapner, {Ronald J.} and Janet Catov and Ida Chen and Saade, {George R.}",
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AU - NHLBI nuMoM2b Heart Health Study

AU - Haas, David M.

AU - Parker, Corette B.

AU - Marsh, Derek J.

AU - Grobman, William A.

AU - Ehrenthal, Deborah B.

AU - Greenland, Philip

AU - Bairey Merz, C. Noel

AU - Pemberton, Victoria L.

AU - Silver, Robert M.

AU - Barnes, Shannon

AU - McNeil, Rebecca B.

AU - Cleary, Kirsten

AU - Reddy, Uma M.

AU - Chung, Judith H.

AU - Parry, Samuel

AU - Theilen, Lauren H.

AU - Blumenthal, Elizabeth A.

AU - Levine, Lisa D.

AU - Mercer, Brian M.

AU - Simhan, Hyagriv

AU - Polito, Lu Ann

AU - Wapner, Ronald J.

AU - Catov, Janet

AU - Chen, Ida

AU - Saade, George R.

PY - 2019/10/1

Y1 - 2019/10/1

N2 - 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.

AB - 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.

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KW - hypertension

KW - preeclampsia

KW - preterm birth

KW - risk

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