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Assessment of Maternal Vascular Remodeling During Pregnancy in the Mouse Uterus
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Cardiovascular Risk Factors Mediate the Long-Term Maternal Risk Associated With Hypertensive Disorders of Pregnancy

Jennifer J Stuart1, Lauren J Tanz2, Eric B Rimm3

  • 1Division of Women's Health, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.

Journal of the American College of Cardiology
|May 13, 2022
PubMed

Insights

Hypertensive disorders of pregnancy (HDP) increase long-term cardiovascular disease (CVD) risk, with risk factors explaining most of this association. Post-pregnancy screening for conditions like hypertension and diabetes is crucial for prevention.

Area of Science:

  • Cardiovascular health
  • Obstetrics and Gynecology
  • Public Health

Background:

  • Hypertensive disorders of pregnancy (HDP), encompassing gestational hypertension and preeclampsia, are recognized contributors to elevated long-term cardiovascular disease (CVD) risk.
  • Understanding the interplay between HDP and subsequent CVD is critical for maternal health outcomes.

Purpose of the Study:

  • To investigate the association between HDP and the incidence of long-term CVD.
  • To quantify the extent to which established CVD risk factors mediate this association.

Main Methods:

  • Utilized data from the Nurses' Health Study II, following 60,379 parous participants without prior CVD.
  • Employed Cox proportional hazards models to assess the relationship between HDP and incident CVD, controlling for confounders.
  • Applied the difference method to determine the proportion of the association mediated by chronic hypertension, hypercholesterolemia, type 2 diabetes, and BMI changes.

Main Results:

  • Women experiencing HDP during their first pregnancy showed a 63% increased rate of CVD compared to normotensive pregnancies.
  • Preeclampsia conferred a higher CVD risk (HR: 1.72) than gestational hypertension (HR: 1.41).
  • Established CVD risk factors accounted for 64% of the HDP-CVD association, mediating 57% for preeclampsia and 84% for gestational hypertension.

Conclusions:

  • Established CVD risk factors, particularly those developing post-pregnancy, significantly mediate the increased CVD risk associated with HDP.
  • Targeted screening for chronic hypertension, hypercholesterolemia, type 2 diabetes, and obesity after pregnancy is recommended for women with a history of HDP to aid in CVD prevention.
Abstract

Keywords:
cardiovascular diseasecardiovascular disease risk factorspreeclampsiapregnancy

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