Author + information
- Received October 14, 2019
- Revision received February 28, 2020
- Accepted March 5, 2020
- Published online May 4, 2020.
- Vesna D. Garovic, MD, PhDa,b,∗ (, )
- Wendy M. White, MD, MPHb,
- Lisa Vaughan, MSc,
- Mie Saiki, MDa,
- Santosh Parashuram, MDa,
- Oscar Garcia-Valencia, MDa,
- Tracey L. Weissgerber, PhDa,
- Natasa Milic, MD, PhDa,d,
- Amy Weaver, MSc and
- Michelle M. Mielke, PhDe,f
- aDivision of Nephrology and Hypertension, Mayo Clinic College of Medicine, Rochester, Minnesota
- bDepartment of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota
- cDivision of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, Minnesota
- dDepartment of Medical Statistics & Informatics, Medical Faculty, University of Belgrade, Belgrade, Serbia
- eDepartment of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota
- fDepartment of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota
- ↵∗Address for correspondence:
Dr. Vesna D. Garovic, Department of Internal Medicine, Division of Nephrology and Hypertension, and Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905.
Background Hypertensive disorders of pregnancy (HDP) are associated with increased risks for cardiovascular disease later in life. The HDP incidence is commonly assessed using diagnostic codes, which are not reliable; and typically are expressed per-pregnancy, which may underestimate the number of women with an HDP history after their reproductive years.
Objectives This study sought to determine the incidence of HDP expressed as both per-pregnancy and per-woman, and to establish their associations with future chronic conditions and multimorbidity, a measure of accelerated aging, in a population-based cohort study.
Methods Using the Rochester Epidemiology Project medical record-linkage system, the authors identified residents of Olmsted County, Minnesota, who delivered between 1976 and 1982. The authors classified pregnancies into normotensive, gestational hypertension, pre-eclampsia, eclampsia, pre-eclampsia superimposed on chronic hypertension, and chronic hypertension using a validated electronic algorithm, and calculated the incidence of HDP both per-pregnancy and per-woman. The risk of chronic conditions between women with versus those without a history of HDP (age and parity 1:2 matched) was quantified using the hazard ratio and corresponding 95% confidence interval estimated from a Cox model.
Results Among 9,862 pregnancies, we identified 719 (7.3%) with HDP and 324 (3.3%) with pre-eclampsia. The incidence of HDP and pre-eclampsia doubled when assessed on a per-woman basis: 15.3% (281 of 1,839) and 7.5% (138 of 1,839), respectively. Women with a history of HDP were at increased risk for subsequent diagnoses of stroke (hazard ratio [HR]: 2.27; 95% confidence interval [CI]: 1.37 to 3.76), coronary artery disease (HR: 1.89; 95% CI: 1.26 to 2.82), cardiac arrhythmias (HR: 1.62; 95% CI: 1.28 to 2.05), chronic kidney disease (HR: 2.41; 95% CI: 1.54 to 3.78), and multimorbidity (HR: 1.25; 95% CI: 1.15 to 1.35).
Conclusions The HDP population-based incidence expressed per-pregnancy underestimates the number of women affected by this condition during their reproductive years. A history of HDP confers significant increase in risks for future chronic conditions and multimorbidity.
Supported by the National Institutes of Health (P50-AG044170, R01-AG034676, UL1TR002377, and R01-HL136348). Dr. Mielke has received unrestricted research grants from Biogen that are unrelated to this study; and has received funding from the National Institute on Aging. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.
- Received October 14, 2019.
- Revision received February 28, 2020.
- Accepted March 5, 2020.
- 2020 American College of Cardiology Foundation
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