Incidence and Long-Term Outcomes of Hypertensive Disorders of Pregnancy.
J Am Coll Cardiol
; 75(18): 2323-2334, 2020 05 12.
Article
em En
| MEDLINE
| ID: mdl-32381164
ABSTRACT
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 12 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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Hipertensão Induzida pela Gravidez
Tipo de estudo:
Diagnostic_studies
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Etiology_studies
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Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Female
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Humans
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Pregnancy
Idioma:
En
Revista:
J Am Coll Cardiol
Ano de publicação:
2020
Tipo de documento:
Article