Maternal Hypertensive Disorders of Pregnancy and Offspring Risk of Hypertension: A Population-Based Cohort and Sibling Study.

Azra Kurbasic,Simon Timpka,Janet W Rich-Edwards,Ingrid Mogren,Göran Hallmans,Paul W Franks,Abigail Fraser

doi:10.1093/ajh/hpy176

Abstract

BACKGROUNDWomen with a history of hypertensive disorders of pregnancy (HDP) are at increased risk of hypertension, cardiovascular disease, and type 2 diabetes. Offspring from pregnancies complicated by HDP also have worse cardiometabolic status in childhood and young adulthood, but the offspring risk of clinical hypertension in adulthood is largely unknown.METHODSWe studied 13,893 first-born adult offspring (49.4% female) who attended a structured population-based primary care visit (The Västerbotten Health Survey) at age 40 years in Sweden between 1994 and 2013. Data on maternal HDP were collected from a population-based birth register. We investigated the association between maternal HDP and the risk of adult offspring hypertension and worse cardiometabolic risk factor status utilizing multivariable poisson and linear regression models. We also conducted a sibling comparison, which inherently accounted for familial factors shared by siblings (N = 135).RESULTSOffspring participants of women with HDP (N = 383, 2.8%) had increased relative risk of hypertension (1.67, 95% confidence interval: 1.38, 2.01) and also higher mean body mass index, systolic blood pressure, diastolic blood pressure, and worse 2-hour 75 g oral glucose tolerance test result at age 40 years. No difference was observed for serum cholesterol. Point estimates for the cardiometabolic risk factors were attenuated in the sibling analyses.CONCLUSIONOffspring born to mothers with a history of HDP are on an adverse cardiometabolic trajectory and should be considered as concomitant targets for primordial prevention of hypertension in the maternal post-pregnancy period.

Highlights

Hypertensive disorders of pregnancy (HDP; including gestational hypertension and pre-eclampsia) are serious complications during pregnancy, and women affected have higher risk of post-pregnancy cardiometabolic disease.[1]
We investigated the association between maternal HDP and offspring body mass index (BMI), Systolic blood pressure (SBP), diastolic blood pressure (DBP), 2-hour oral glucose tolerance test (OGTT) result, and log-transformed total serum cholesterol, respectively
At age 40 years, there were no substantial differences in smoking status or education level between participants exposed and not Pregnancy Hypertension and Offspring Hypertension exposed to maternal HDP

Summary

Introduction

Hypertensive disorders of pregnancy (HDP; including gestational hypertension and pre-eclampsia) are serious complications during pregnancy, and women affected have higher risk of post-pregnancy cardiometabolic disease.[1]. American Journal of Hypertension 32(4) April 2019 331 to normotensive mothers These differences persist in young adulthood[4] and might even translate into an increased risk of type 2 diabetes[5] and stroke[6] later in life. Results from animal models suggest that reduced uterine perfusion and exposure to anti-angiogenic factors during gestation—mimicking preeclampsia—can result in higher long-term blood pressure in the offspring, potentially mediated through altered cardiovascular structure and function.[7] Yet, a sibling analysis of young adult offspring suggested that the association between maternal HDP and offspring cardiometabolic risk factors might be largely attributable to shared familial factors.[4] no study has presented clinically measured hypertension data on middle-aged adults born to hypertensive or preeclamptic women and included analysis of non-exposed siblings.[8]

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