227. Can cardiovascular adaptation in early pregnancy predict later hypertension?

Abstract

Introduction The mechanism behind the increased risk for cardiovascular disease (CVD) after preeclampsia (PE) is unclear, both preexisting cardiovascular dysfunction and harmful effects of the preeclamptic episode have been proposed. Objective To compare risk factors for CVD during pregnancy and at a later follow up in women with a history of severe PE and women without such a history. A secondary aim was to evaluate risk factors for prediction of later hypertension (HT). Methods Women treated at Danderyd University Hospital, Stockholm, Sweden between 1999 and 2004, for severe PE and controls with normal pregnancies matched for age, year of delivery and parity were contacted between 2013 and 2016. Of 148 with PE, 82 agreed to participate and 84 of 172 invited controls. Data from the index pregnancy were retrieved from medical records. At follow up blood pressure, BMI, waist measurement and level of HbA1c as well as family history of CVD and hypertensive medication were registered. Results In the group with PE three had HT before the index pregnancy versus none in the control group. At follow up 24 of 82 (29.3%) in the PE group had HT versus 9 out of 84 (10.7 %) (p = 0.003) in the control group. In women with only one episode of PE the rate of HT was 4.5% versus 52.9% (p = 0.003) in those with more than one. All variables were introduced in a logistic regression with stepwise analysis. Three variables were significantly related to HT at follow up: Systolic blood pressure ( equal to or more than 120) and BMI (equal or more than 25) in early pregnancy as well as family history of CVD. History of PE was not significantly related. Conclusion Blood pressure in early pregnancy may indicate impaired cardiovascular adaptation and be an indication of later hypertension.