Abstract P265: History of Hypertensive Disorders of Pregnancy and Early Manifestation of Vasomotor Symptoms 8-10 Years Post Delivery

Abstract

Introduction: Women with hypertensive disorders of pregnancy (HDP) have excess cardiovascular disease (CVD) risk in the years following delivery compared with women with uncomplicated pregnancies, with black women having excess burden of both HDP and CVD. After pregnancy yet prior to the menopause transition, nearly 30% of women in their late reproductive years report having vasomotor symptoms (VMS) including night sweats and hot flashes. VMS, particularly, early-onset VMS, have also been associated with increases in blood pressure and subclinical CVD. However, it is unknown if underlying vascular dysfunction in women with a history of HDP may increase the risk of VMS and contribute to racial differences in symptom manifestation. Hypothesis: Women with a history of HDP will have an increased risk of VMS as compared with women without a history of HDP. Methods: Women with a singleton live birth at Magee-Womens Hospital (Pittsburgh, PA) during 2008-2009 were enrolled 8-10 years post-delivery (median age=37.5; interquartile range=8.0) in our ongoing prospective cohort study assessing maternal cardiometabolic and microvascular disease (n=312). Using log-binomial logistic regression, we estimated the risk of VMS associated with history of HDP, adjusting for race, body mass index, current smoking, age, and education. Additional adjustment was made for current hormonal contraceptive use. Women with single or double oophorectomy (n=7) were excluded in a sensitivity analysis. Given the excess burden of HDP and CVD, as well as early-onset VMS in black women, we also assessed effect measure modification by maternal race. Results: Thirty percent of women with a history of HDP reported having vasomotor symptoms compared with 18% of women without a history of HDP. This excess risk of VMS persisted after accounting for covariates (adjusted risk ratio (aRR) 1.61, 95% confidence interval (CI) 1.06, 2.47). Excess risk of VMS persisted in women with a history of HDP after excluding those with a single or double oophorectomy (aRR 1.60, 95% CI 1.03, 2.47). Additional adjustment for hormonal contraceptive use resulted in a non-statistically significant increased risk of VMS (aRR 1.59, 95% CI 0.98, 2.59). Race did not modify the association between history of HDP and VMS (P value for interaction = 0.79). Conclusions: History of HDP was associated with excess risk of VMS in young women prior to menopause transition. There may be common underlying vascular changes that contribute to HDP and VMS that may also place women at future risk for CVD. How these reproductive factors may converge and be related to excess cardiometabolic risk warrants additional study.