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Prediction of 10-Year Incident Hypertension After Pregnancy: A Population-Based Cohort Study
Zhixun Yang1,2, Hendrikus J A Van Os2,3, Janet M Kist1
1Health Campus The Hague, Department of Public Health & Primary Care, Leiden University Medical Centre, Leiden, the Netherlands.
Objective:
To develop a model including pregnancy-related factors for the prediction of incident hypertension after pregnancy and to assess the impact of pregnancy-related factors on model performance.
Design:
Population-based cohort study.
Setting:
Routine primary care data linked to the data from the Dutch Perinatal Registry and Statistics Netherlands.
Population:
Women with a first childbirth at ≥ 24 weeks' gestation between 2007 and 2019 were included and were followed for up to 10 years after childbirth.
Methods:
Two Cox proportional hazards models were developed to estimate the 10-year risk of hypertension. Model 1 included sociodemographic factors and CVD-related factors, while model 2 additionally included pregnancy-related factors.
Main Outcome Measures:
Ten-year risk of incident hypertension.
Results:
We included 28 234 women, of which 639 developed hypertension (cumulative 10-year incidence 3.3%). The C-index of model 1 was 0.659 (95% CI: 0.642-0.684) and increased to 0.772 (95% CI: 0.754-0.796) after the addition of pregnancy-related factors. The C-index difference was 0.113 (95% CI: 0.092-0.132), mostly driven by the inclusion of hypertensive disorders of pregnancy. Net reclassification improvement was 0.213 (95% CI: 0.159-0.273) for events and 0.001 (95% CI: -0.004 to 0.006) for non-events.
Conclusions:
Our prediction model for hypertension showed good discrimination and calibration after the addition of pregnancy-related factors. This model may help to target cardiovascular risk management for women with a high risk of hypertension after pregnancy in order to improve women's cardiovascular health.
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