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The Association Between Hypertensive Disorders in Pregnancy and the Risk of Developing Chronic Hypertension
Jiahao Xu1, Ting Li1, Yixiao Wang1
1Department of Obstetrics and Gynecology, Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, China.
Insights
Hypertensive disorders in pregnancy (HDP), including preeclampsia (PE) and gestational hypertension (GH), significantly increase the risk of developing chronic hypertension later in life. This risk persists even after adjusting for other common risk factors.
Area of Science:
- Obstetrics and Gynecology
- Cardiovascular Health
- Epidemiology
Background:
- Hypertensive disorders in pregnancy (HDP) encompass conditions like preeclampsia (PE) and gestational hypertension (GH).
- The long-term cardiovascular implications of HDP, particularly the risk of developing chronic hypertension, require comprehensive evaluation.
- Understanding these associations is crucial for maternal health and preventative strategies.
Approach:
- A systematic review and meta-analysis was conducted using data from PubMed, Embase, and Cochrane Library up to August 2021.
- Twenty-one studies involving 634,293 patients were analyzed to determine the odds ratios (OR) for developing chronic hypertension.
- Meta-regression and subgroup analyses were performed to explore heterogeneity and adjust for confounding factors like age and BMI.
Key Points:
- Women with a history of HDP are 3.6 times more likely to develop chronic hypertension.
- Gestational hypertension (GH) and preeclampsia (PE) are associated with 6.2 and 3.2 times increased likelihood, respectively.
- Adjusted analyses confirmed that HDP and PE remain significant risk factors for chronic hypertension, with Asian populations showing a higher relative risk.
Conclusions:
- Hypertensive disorders in pregnancy (HDP), including GH and PE, are independent risk factors for developing chronic hypertension.
- The association between HDP and chronic hypertension is robust, persisting after adjustment for key demographic and clinical factors.
- These findings underscore the importance of long-term cardiovascular monitoring for women with a history of HDP.
Objective:
This meta-analysis comprehensively evaluated the association between hypertensive disorders in pregnancy (HDP) and the risk of developing chronic hypertension and the associations between specific types of HDP, including preeclampsia (PE) and gestational hypertension (GH), and the risk of developing chronic hypertension.
Design:
Systematic review and meta-analysis.
Data Sources:
The PubMed, Embase and Cochrane Library databases were searched from inception to August 20, 2021.
Methods:
Depending on heterogeneity, the combined odds ratio (OR) of the 95% confidence interval (CI) was obtained with a random-effects or fixed-effects model. We used meta-regression analysis to explore the sources of heterogeneity. We analyzed the OR value after adjusting for age and BMI at recruitment, prepregnancy BMI, age at first delivery, and other factors. Additionally, we evaluated the results of the subgroup analysis by the year of publication (< 2016, ≥ 2016), study design, sample size (< 500, ≥ 500), region (North and South America, Europe, and other regions) and NOS score (< 7, ≥ 7).
Results:
Our systematic review and meta-analysis comprehensively explored the relationships between HDP, GH, and PE and chronic hypertension. Twenty-one articles that included 634,293 patients were included. The results of this systematic review and meta-analysis suggested that women with a history of HDP are almost 3.6 times more likely to develop chronic hypertension than those without a history of HDP, women with a history of GH are almost 6.2 times more likely to develop chronic hypertension than those without a history of GH, and women with a history of PE are almost 3.2 times more likely to develop chronic hypertension than those without a history of PE. In addition, we further calculated the probability of developing chronic hypertension among patients with HDP or PE after adjusting for age and BMI at recruitment, prepregnancy BMI, age at first delivery, and other factors. The results suggested that women with a history of HDP are almost 2.47 times more likely to develop chronic hypertension than those without a history of HDP and that women with a history of PE are almost 3.78 times more likely to develop chronic hypertension than those without a history of PE. People in Asian countries are more likely to develop chronic hypertension after HDP or PE, while American people are not at high relative risk.
Conclusion:
These findings suggest that HDP, GH, and PE increase the likelihood of developing chronic hypertension. After adjustment for age and BMI at recruitment, prepregnancy BMI, age at first delivery, and other factors, patients with HDP or PE were still more likely to develop chronic hypertension. HDP may be a risk factor for chronic hypertension, independent of other risk factors. GH and PE, as types of HDP, may also be risk factors for chronic hypertension.
Systematic Review Registration:
[www.ClinicalTrials.gov], identifier [CRD42021238599].
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