Abstract MP39: Incident Heart Failure Within Five Years of Delivery Among Women With Hypertensive Disorders of Pregnancy or Pre-pregnancy Hypertension in a Diverse Population

Abstract

Introduction: Hypertensive disorders of pregnancy (HDP) and pre-pregnancy hypertension are associated with increased morbidity and mortality for the mother, with potential long-term implications. We investigated the relationships between HDP and pre-pregnancy hypertension with fatal and nonfatal incident maternal heart failure (HF) within five years of delivery, and examined racial/ethnic differences. Methods: A retrospective population-based study was conducted among 433,636 women aged 13-49 (58.7% non-Hispanic white [NHW], 31.8% non-Hispanic black [NHB], 9.5% Hispanic) with a live, singleton birth in South Carolina between 2004-2016. HDP were defined as pre-eclampsia, eclampsia, or gestational hypertension based on hospitalization/emergency department (ED) visit data, or HDP on birth certificates. Pre-pregnancy hypertension was based on hospitalization/ED visit data or birth certificates. Incident HF was defined by hospital/ED visit and death certificate data. Cox proportional hazards models adjusted for sociodemographic, behavioral, and clinical characteristics. Results: Eighteen percent of women were diagnosed with HDP in ≥1 pregnancy (n=78,317; 53.5% NHW, 40.8% NHB, 5.7% Hispanic). Of the 433,636 women, 2.3% had pre-pregnancy hypertension with superimposed HDP, 15.7% had no pre-pregnancy hypertension with HDP, 0.4% had pre-pregnancy hypertension without superimposed HDP and 81.6% had neither condition. Compared to those without pre-pregnancy hypertension or HDP, incident HF risk was increased for women with: no pre-pregnancy hypertension with HDP (HR=4.35; 95% CI: 4.01-4.71), pre-pregnancy hypertension without superimposed HDP (HR=5.07; 95% CI: 3.52-7.29), and pre-pregnancy hypertension with superimposed HDP (HR=6.66; 95% CI: 5.91-7.51). The table shows race/ethnic specific estimates of incident HF risk. Discussion: Women with HDP and pre-pregnancy hypertension were at higher risk for HF or HF death within five years of delivery and the risk varied across racial/ethnic groups.