History Of Hypertensive Disorders Of Pregnancy Research Articles

Postpartum Lifestyle Behaviors among Women with Hypertensive Disorders of Pregnancy: Data from the HUNT Study.

Hypertensive disorders of pregnancy (HDP) are associated with an increased risk of cardiovascular disease later in life. Clinical guidelines for postpartum follow-up after HDP often recommend lifestyle counseling to reduce this risk. However, knowledge about lifestyle behaviors and perceptions among women with a history of HDP is limited. We linked data from the fourth survey of the population-based Trøndelag Health Study (HUNT4) with data from the Medical Birth Registry of Norway. The associations between HDP and postpartum lifestyle behaviors and perceptions were examined using multivariable logistic regression. In a secondary analysis, HUNT4 participants with a recent history of pre-eclampsia were compared with women with a recent history of pre-eclampsia participating in a postpartum pilot intervention study. Lifestyle behaviors and perceptions were self-reported and included diet (intake frequency of fruits, vegetables, meat, fish, and sugar-sweetened beverages), alcohol intake, physical activity, sleep, smoking, lifestyle satisfaction, and the importance of a healthy lifestyle. Among 7551 parous HUNT4 participants, 610 had a history of HDP. We found no differences in lifestyle behaviors between women with and without a history of HDP. However, women with HDP had higher odds of being unsatisfied with their lifestyle. Women with pre-eclampsia participating in a postpartum lifestyle intervention study tended to have a healthier lifestyle at baseline than women participating in HUNT4. Future studies should explore how lifestyle intervention programs could be adapted to the needs of women who have experienced HDP or other pregnancy complications that are associated with an increased risk of CVD.

Association of activin A and postpartum blood pressure in peripartum cardiomyopathy

BackgroundActivin A has been implicated in the pathogenesis of patients with chronic hypertension and heart failure as well as patients with hypertensive disorders of pregnancy (HDP). Whether activin A correlates with blood pressure in patients with peripartum cardiomyopathy (PPCM) and HDP history has not previously been explored. Methods and results82 women with PPCM w/ and w/out HDP or hypertension history were selected for analysis from the Investigations in Pregnancy Associated Cardiomyopathy (IPAC) study. Serum biomarkers and blood pressure were assessed at the time of enrollment (median postpartum day 24). Levels of both sFlt-1 (SBP: r 0.47, p = 0.008; DBP: r 0.57, p < 0.001) and activin A (SBP: r 0.59, p < 0.001;DBP: r 0.68, p < 0.001) were noted to significantly correlate with blood pressure in patients with a history of HDP who went on to develop PPCM, but not in patients with chronic hypertension or no hypertensive history. The strongest correlation was between activin A levels and postpartum diastolic blood pressure for the subset with preeclampsia (DBP: r0.82, p < 0.001). This remained significant in multivariable linear regression analysis (DBP: β = 0.011, p = 0.015). ConclusionIn patients with PPCM, activin A and sFlt-1 levels had direct correlations with both systolic (SBP) and diastolic blood pressures (DBP), but only in participants with history of HDP. This correlation was more evident for activin A and strongest with a history of preeclampsia. Our findings suggest that activin A may play an important role in blood pressure modulation in women with HDP who subsequently develop PPCM.

Hypertensive Disorders of Pregnancy are Associated with Cardiovascular Disease in Middle- and Older-Aged Japanese Women.

Hypertensive disorders of pregnancy (HDP) are estimated to occur in up to 10% of all pregnancies and are associated with an increased risk of future cardiovascular disease (CVD) and chronic hypertension (HT). Therefore, we examined the impact of a history of HDP on CVD possibility in middle- and older-aged Japanese women. We used the Tohoku Medical Megabank database to obtain the data of 26,024 menopausal women who were aged ≥ 50 years, had children, did not smoke, and did not have chronic kidney disease and to analyze the relationship between HDP history and CVD. A history of HDP was found in 4.6% of women. We divided the women into four groups according to the presence or absence of HDP and HT. The percentage of women with dyslipidemia, diabetes mellitus, and body mass index of ≥ 25 kg/m2 was the highest in the HDP＋ HT＋ group compared to the other groups (43.4%, 24.0%, and 45.2%, respectively). Adjusted odds ratio (OR) for the combined six CVD categories was higher for those with a history of HDP alone (OR [95% confidence interval [CI]]: 1.61 [1.03-2.53]). Moreover, the OR was significantly higher for those with combination with HDP history and HT (OR [95% CI]: 4.11 [3.16-5.35]). The prevalence of individual CVD was also the highest in the HT＋ HDP＋ group. An HDP history can influence the risk of CVD in Japanese women, indicating the importance of information about pregnancy outcomes in health management.

Barriers and Facilitators to Cardiovascular Disease Prevention Following Hypertensive Disorders of Pregnancy in Primary Care: Cross-Sectional Surveys.

Women with a history of hypertensive disorders of pregnancy (HDP) have an increased risk of cardiovascular disease (CVD). Guidelines recommend that women diagnosed with HDP should be advised of their increased CVD risk, have regular blood pressure monitoring by their general practitioner (GP), and adopt healthy lifestyle behaviours. However, within Australia, the current practice in primary health care is unknown. The aim of this study was to describe current practices, barriers, and facilitators to the provision of CVD preventative services for women after HDP in the primary care setting and to identify potential strategies to support GPs in providing recommended care. Separate cross-sectional online surveys were undertaken with 35 GPs and 105 women with a history of HDP. Surveys included both closed- and open-ended questions. Closed-ended questions were analysed using basic descriptive statistics, and open-ended questions were themed and tallied. The survey of GPs revealed that GPs are more likely to assess traditional CVD risk markers than lifestyle risk factors or HDP history. GPs identified a lack of resources and skills as barriers to providing CVD preventative care post-HDP. The survey with women after HDP revealed that women with a history of HDP are more likely to be assessed for blood pressure than lifestyle CVD risk factors, and that the women's barriers to obtaining care included difficulty obtaining an appointment and time required for attending appointments. Strategies to improve CVD preventative care were consistent between surveys, where 70% of GPs and 59% of women chose 'increasing women's awareness of increased CVD risk' and 67% of GPs and 55% of women chose 'improving communication between hospitals and primary care' as their preferred strategies. While the findings suggest that women with a history of HDP are receiving advice consistent with guidelines for traditional CVD risk markers, such as blood pressure, they are less likely to receive CVD preventative care for lifestyle or female-specific CVD risk factors.

Hypertensive Disorders of Pregnancy and Risk of Stroke in U.S. Black Women

BackgroundBlack women have a disproportionately higher burden of both preeclamptic pregnancy and stroke compared with White women, but virtually all existing evidence on this possible association has been generated from women of European ancestry.MethodsIn the Black Women’s Health Study, a prospective cohort of U.S. Black women who enrolled in 1995, 42,924 participants were parous and free of cardiovascular disease at baseline. Biennial questionnaires included questions on preeclampsia, gestational hypertension, and stroke. We sought the medical records for participants who reported a stroke, and we reviewed them blinded to reproductive history. Cox proportional-hazards models, with control for potential confounders, were used to estimate hazard ratios and 95% confidence intervals (CIs).ResultsOver a median of 22 years of follow-up, there were 1555 incident strokes, including 310 among 4938 women with a history of hypertensive disorders of pregnancy (HDOP). The multivariable hazard ratio for stroke for women with any HDOP compared with those who had never experienced HDOP was 1.66 (95% CI, 1.46 to 1.89). Comparable hazard ratios were 1.53 (95% CI, 1.29 to 1.82) for preeclampsia and 1.81 (95% CI, 1.53 to 2.13) for gestational hypertension only. Associations were similar among women under age 55 years and those aged 55 years and older.ConclusionsIn this prospective study of Black women, a history of HDOP was associated with an estimated 66% increased long-term risk of stroke. This association may contribute to the disproportionately higher stroke incidence in Black women given the higher prevalence of HDOP in this population. (Funded by the U.S. National Institutes of Health.)

Pre-eclampsia and Cardiovascular Disease: From Pregnancy to Postpartum.

Hypertensive disorders of pregnancy (HDP) complicate approximately 10% of pregnancies. In addition to multiorgan manifestations related to endothelial dysfunction, HDP confers an increased risk of cardiovascular disease during delivery hospitalisation, such as heart failure, pulmonary oedema, acute MI and cerebrovascular events. However, the cardiovascular legacy of HDP extends beyond birth since these women are significantly more likely to develop cardiovascular risk factors in the immediate postnatal period and major cardiovascular disease in the long term. The main mediator of cardiovascular disease in women with a history of HDP is chronic hypertension, followed by obesity, hypercholesterolaemia and diabetes. Therefore, optimising blood pressure levels from the immediate postpartum period until the first months postnatally could have beneficial effects on the development of hypertension and improve long-term cardiovascular health. Peripartum screening based on maternal demographic, and clinical and echocardiographic data could help clinicians identify women with HDP at highest risk of developing postpartum hypertension who would benefit from targeted primary cardiovascular prevention.

0819 Does Sleep Health Modify the Relationship Between Hypertensive Disorders of Pregnancy and Incident Cardiovascular Disease?

Abstract Introduction With pregnancy considered a cardiovascular “stress test”, adverse pregnancy outcomes (APOs), such as gestational hypertension, have been associated with higher risk of poor cardiometabolic health later in life. Sleep has been identified as a contributor to cardiometabolic health; however, few studies have considered how sleep may affect APO-associated cardiovascular disease risk. Methods To investigate sleep health during middle-to-older adulthood as a potential modifier of longitudinal associations between hypertensive disorders of pregnancy (HDP) and CVD incidence, we used data collected from 32,313 parous women (mean±SD age 55±8.9 years) without prior CVD in the Sister Study (enrollment: 2003-2009; n=1,407 Hispanic/Latina, n=2,411 non-Hispanic (NH)-Black, n=27,683 NH-White, and n=812 another race/ethnicity). Report of physician-diagnosed CVD or death from CVD (i.e., heart failure, myocardial infarction, stroke) was collected over follow-up until October 2020. At enrollment, participants reported a history of HDP (i.e., gestational hypertension, preeclampsia, eclampsia) and current sleep health characteristics (i.e., short (&amp;lt; 7 hours) habitual sleep duration, frequent napping, insomnia symptoms; all yes vs. no). Adjusting for sociodemographic, health behavior, and clinical characteristics, Cox proportional hazards regressions estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD among participants with vs. without history of HDP. Wald tests assessed HDP*sleep characteristics interactions. Results Overall, 11% of women reported a history of HDP, and prevalence varied by racial/ethnic group (14% among NH-Black and Latina, 12% another race/ethnicity, 11% NH-White). Poor sleep characteristics were prevalent and more frequent among participants with a history of HDP (e.g., insomnia symptoms: 46% vs. 43% [no HDP]). Over a mean±SD 12±3.0 years of follow-up, there were 1,658 new cases of CVD. After adjustment, the association between HDP and higher risk of CVD (HR=1.40 [95% CI:1.22-1.60]) did not differ between participants with poor vs. non-poor sleep (all p-interactions &amp;gt; 0.05; e.g., short sleep: HRyes=1.41 [1.11-1.79] and HRno=1.34 [1.13-1.59]). Conclusion Using subjective measures, poor sleep during middle-to-older age did not appear to exacerbate risk of CVD associated with HDP. Future studies that include multiple dimensions of objective sleep measured over the life course are warranted to better elucidate how sleep health among parous women may impact CVD risk. Support (if any) NIEHS (Z1AES103325[CLJ] and Z01ES044005 [DPS])

Current status of long-term follow-up system for women with a history of hypertensive disorders of pregnancy: the HDP-PPAP study (HDP-Postpartum in Aomori prefecture study)

Objective Women with a history of hypertensive disorders of pregnancy (HDP), especially those with gestational hypertension and preeclampsia, are more likely to develop hypertension, cerebrovascular disease, ischemic heart disease, diabetes mellitus, dyslipidemia, and chronic kidney disease later in life. However, the risk of lifestyle-related diseases in the immediate postpartum period among Japanese women with preexisting HDP is unclear, and a follow-up system for women with preexisting HDP has not been established in Japan. The purpose of this study was to examine the risk factors for lifestyle-related diseases in Japanese women in the immediate postpartum period and the usefulness of HDP follow-up outpatient clinics based on the situation of the HDP follow-up outpatient clinic at our hospital. Method We included 155 women with a history of HDP who visited our outpatient clinic between April 2014 and February 2020. We examined the reasons for dropout during the follow-up period. We also examined the number of new cases of lifestyle-related diseases and compared Body Mass Index(BMI), blood pressure values, and blood and urine test results at 1 and 3 years postpartum in 92 women who had been continuously followed for more than 3 years postpartum. Results The average age of our patient cohort was 34.8 ± 4.5 years. A total of 155 women with previous HDP were continuously followed for more than 1 year, of whom 23 had new pregnancies, and eight had recurrent HDP (recurrence rate 34.8%). Of the 132 patients who were not newly pregnant, 28 dropped out during follow-up, the most common reason being that the patient did not show up. The patients in this study developed hypertension, diabetes mellitus, and dyslipidemia within a short period. Both systolic and diastolic blood pressures were at normal high levels at 1-year postpartum, and BMI significantly increased at 3 years postpartum. Blood tests revealed significant deterioration in creatinine (Cre), estimated glomerular filtration rate (eGFR), and γ-glutamyl transpeptidase (γGTP) levels. Conclusion In this study, women with preexisting HDP were found to have developed hypertension, diabetes, and dyslipidemia several years postpartum. We also found a significant increase in BMI and worsening of Cre, eGFR, and γGTP levels at 1 and 3 years postpartum. Although the 3-year follow-up rate at our hospital was relatively good (78.8%), some women discontinued follow-up due to self-interruption or relocation, suggesting the need to establish a nationwide follow-up system.

Association of Hypertensive Disorders of Pregnancy With Cognition in Later Life.

Studies of hypertensive disorders of pregnancy (HDP), including gestational or chronic hypertension (GH/CH) and preeclampsia/eclampsia (PE/E), suggest associations with early-life and mid-life cognition but have been limited by self-report or use of diagnostic codes, exclusion of nulliparous women, and lack of measurement of cognition in later life. We examined the effects of any HDP, GH/CH, PE/E, and nulliparity on cognition in later life. Participants included 2,239 women (median age 73) enrolled in the Mayo Clinic Study of Aging with medical record-abstracted pregnancy information. A cognitive battery of 9 tests was conducted every 15 months. Global cognitive and domain-specific z scores (memory, executive/attention, visuospatial, and language) were outcomes. Linear mixed-effect models evaluated associations between pregnancy history (all normotensive, any HPD, HPD subtype [GH/CH, PE/E], or nulliparous) and cognitive decline, adjusting for age and education. Additional models adjusted for APOE, smoking, hypertension, dyslipidemia, body mass index (BMI), diabetes, stroke, and heart disease. Interactions between pregnancy history and age or education on cognitive performance were examined. Of the 2,239 women, 1,854 (82.8%) had at least 1 pregnancy (1,607 all normotensive, 100 GH/CH, and 147 PE/E); 385 (17.2%) were nulliparous. Cognitive performance did not cross-sectionally differ for women with a history of any HDP, GH/CH, or PE/E vs women with a history of all normotensive pregnancies; women who were nulliparous had lower global and domain-specific cognition (all p < 0.05) in age- and education-adjusted models. There was an interaction (p = 0.015) between nulliparity and education such that the lower cognitive performance was most pronounced among nulliparous women with ≤12 years of education (beta = -0.42, p < 0.001) vs 12 + years (b = -0.11, p = 0.049). Longitudinally, women with any HDP had greater declines in global cognition and attention/executive z scores compared with women with all normotensive pregnancies. When stratified by HDP type, only women with PE/E had greater declines in global cognition (beta = -0.04, p < 0.001), language (beta = -0.03, p = 0.001), and attention (beta = -0.04, p < 0.001) z scores. Adjustment for vascular risk factors, BMI, smoking, and APOE did not attenuate results. Women with a history of HDP, especially PE/E, are at greater risk of cognitive decline in later life.

Breastfeeding and Later-Life Cardiometabolic Health in Women With and Without Hypertensive Disorders of Pregnancy.

Background Breastfeeding is associated with improved cardiometabolic profiles decades after pregnancy. Whether this association exists for women who experience hypertensive disorders of pregnancy (HDP) is unknown. The authors examined whether breastfeeding duration or exclusivity are associated with long-term cardiometabolic health, and whether this relationship differs by HDP status. Methods and Results Participants (N=3598) were from the UK ALSPAC (Avon Longitudinal Study of Parents and Children) cohort. HDP status was assessed by medical record review. Breastfeeding behaviors were assessed by contemporaneous questionnaires. Breastfeeding duration was categorized as never, <1, 1 to <3, 3 to <6, 6 to <9, and 9+ months. Breastfeeding exclusivity was categorized as never, <1, 1 to <3, and 3 to 6 months. Measures of cardiometabolic health (body mass index, waist circumference, C-reactive protein, insulin, proinsulin, glucose, lipids, blood pressure, mean arterial pressure, carotid intima-media thickness, and arterial distensibility) were measured 18 years after pregnancy. Analyses were conducted using linear regression adjusting for relevant covariates. Breastfeeding was associated with improved cardiometabolic health (lower body mass index, waist circumference, C-reactive protein, triglycerides, insulin, and proinsulin) in all women, but not for every breastfeeding duration. Interaction tests revealed additional benefits in women with a history of HDP, with the strongest benefit observed in the 6- to 9-month breastfeeding category (diastolic blood pressure, -4.87 mm Hg [95% CI, -7.86 to -1.88], mean arterial pressure -4.61 [95% CI, -7.45 to -1.77], and low-density lipoprotein cholesterol, -0.40 mmol/L [95% CI, -0.62 to -0.17 mmol/L]). Differences in C-reactive protein and low-density lipoprotein "survived" Bonferroni correction (P<0.001). Similar results were observed in the exclusive breastfeeding analyses. Conclusions Breastfeeding may be a mechanism to reduce the cardiovascular disease sequela associated with HDP; however, there is a need to establish whether associations reflect a causal effect.

Modifiable Risk Factors for Cardiovascular Disease among Women with and without a History of Hypertensive Disorders of Pregnancy.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in women. Hypertensive disorders of pregnancy (HDP) affect 5-10% of pregnancies worldwide, and are an independent risk factor for CVD. A greater understanding of the rates of modifiable CVD risk factors in women with a history of HDP can inform CVD prevention priorities in this group. The aim of this study was to understand the rates of individual and multiple modifiable risk factors for CVD (body mass index, fruit and vegetable intake, physical activity, sitting time, smoking, alcohol consumption and depressive symptoms) among women with a history of HDP, and assess whether they differ to women without a history of HDP. This study is a cross-sectional analysis of self-reported data collected for the Australian Longitudinal Study of Women's Health (ALSWH). The sample included 5820 women aged 32-37 years old, who completed survey 7 of the ALSWH in 2015. Women with a history of HDP had a higher multiple CVD modifiable risk factor score compared to those without HDP (mean (SD): 2.3 (1.4) vs. 2.0 (1.3); p &lt; 0.01). HDP history was significantly associated with a higher body mass index (p &lt; 0.01), high-risk alcohol consumption (p = 0.04) and more depressive symptoms (p &lt; 0.01). Understanding that women with a history of HDP have higher CVD risk factors, specifically body mass index, alcohol consumption and depressive symptoms, allows clinicians to provide appropriate and tailored CVD interventions for this group of women.

Hypertensive disorders of pregnancy and long‐term cardiovascular health: FIGO Best Practice Advice

Hypertensive disorders of pregnancy (HDP) are the most common causes of maternal and perinatal morbidity and mortality. They are responsible for 16% of maternal deaths in high-income countries and approximately 25% in low- and middle-income countries. The impact of HDP can be lifelong as they are a recognized risk factor for future cardiovascular disease. During pregnancy, the cardiovascular system undergoes significant adaptive changes that ensure adequate uteroplacental blood flow and exchange of oxygen and nutrients to nurture and accommodate the developing fetus. Failure to achieve normal cardiovascular adaptation is associated with the development of HDP. Hemodynamic alterations in women with a history of HDP can persist for years and predispose to long-term cardiovascular morbidity and mortality. Therefore, pregnancy and the postpartum period are an opportunity to identify women with underlying, often unrecognized, cardiovascular risk factors. It is important to develop strategies with lifestyle and therapeutic interventions to reduce the risk of future cardiovascular disease in those who have a history of HDP.

Hypertensive disorders of pregnancy and markers of vascular brain pathology after 15 years: a prospective cohort study

AbstractBackgroundSubstantial evidence suggests an association between hypertensive disorders of pregnancy (HDP) and long term cerebrovascular health. We aimed to determine the associations between HDP and markers of vascular brain pathology fifteen years after pregnancyMethodThis was a nested cohort study embedded in a population‐based prospective cohort followed from early pregnancy. We included 538 women, 445 (82.7%) with normotensive index pregnancies and 93 (17.2%) with HDP in the index pregnancy. Fifteen years after pregnancy (median of 14.6 years 90% range 14.0; 15.7), women had a mean age of 46.5 years (SD = 4.2). These women underwent magnetic resonance imaging to assess brain tissue volumes as well as white matter hyperintensities (WMH), lacunar infarcts, and cerebral microbleeds as markers of vascular brain pathology.ResultWomen with prior HDP had 38% (95% CI: [8% ; 75%]) higher WMH volume compared to women with previous normotensive pregnancy. This association was driven by women with gestational hypertension, who had 48% (95% CI: [11% ; 95%]) higher WMH volume compared to women with previous normotensive pregnancy. No differences were found with infarcts or cerebral microbleeds. The development of chronic hypertension after pregnancy strengthened this result, especially in women with previous gestational hypertension.ConclusionA history of HDP was associated with more WMH burden fifteen years after pregnancy. This effect was driven by women with previous gestational hypertension. The development of chronic hypertension after pregnancy contributed to this effect. Women with a history of HDP should be evaluated and treated early for hypertension and other cardiovascular risk factors.

Abstract 14907: Association Between Adverse Pregnancy Outcomes and N-Terminal Pro-Brain Natriuretic Peptide 2-7 Years After Delivery: Numom2b Heart Health Study

Introduction: Adverse pregnancy outcomes (APOs), including gestational diabetes (GDM), hypertensive disorders of pregnancy (HDP), preterm birth (PTB), and small-for-gestational age (SGA), have been associated with increased risk of heart failure (HF), but mechanisms are poorly understood. We sought to examine the association between a history of APO and N-terminal pro-brain natriuretic peptide (NT-proBNP), a HF biomarker, after delivery. Methods: We included individuals from the NuMoM2b Heart Health Study who were recruited during their first pregnancy and followed longitudinally. We excluded individuals who had pre-pregnancy hypertension or diabetes. APOs were centrally adjudicated based on medical records. NT-proBNP was assessed at follow-up visit after delivery. We examined the association between a history of APO and elevated NT-proBNP (≥125 pg/mL) with logistic regression. We log-transformed NT-proBNP and also examined the association between history of APO and NT-proBNP with linear regression. Models were adjusted for demographic and cardiovascular risk factors at the time of NT-proBNP. Results: Of 4172 individuals, mean (SD) age was 30.7(5.6) years at 3 years follow-up after delivery and 170 (4%) had a history of GDM, 597 (14%) HDP, 321 (8%) had PTB, and 170 (4%) had SGA. Among the study population, 256 (6%) had elevated NT-proBNP. Individuals with GDM had a lower risk of elevated NT-proBNP levels (adjusted odds ratio 0.59 [95% confidence interval 0.38, 0.92]); while a history of HDP, PTB, or SGA was not associated with elevated NT-proBNP ( TABLE ). When NT-proBNP was examined as a continuous variable, a history of GDM (-0.20 [-0.35, -0.06] pg/mL) or HDP (-0.09 [-0.15, -0.02]) was associated with lower log-transformed NT-proBNP levels in adjusted models. Conclusions: In this cohort study, APOs were not associated with elevations in NT-proBNP, but GDM and HDP were paradoxically associated with lower NT-proBNP levels at 3 years post-delivery.

Association Between Hypertensive Disorders of Pregnancy and Dementia: a Systematic Review and Meta-Analysis.

Prior meta-analyses report a 2- to 4-fold increased risk of later cardiovascular disease among women with a history of hypertensive disorders of pregnancy (HDP). Given HDP's vascular underpinnings, it is hypothesized to also be a risk factor for later dementia. We aim to summarize the evidence for the impact of HDP on dementia and consider unique associations between HDP and dementia subtypes. Observational studies on the relationship between HDP and dementia were identified from online electronic databases to July 1, 2021 (PROSPERO identifier: CRD42020185630). We included observational studies published in English. Exposure among women was any HDP and HDP subtypes: gestational hypertension, preeclampsia/eclampsia, or other/unspecified HDP. Outcome was any dementia and dementia subtypes: Alzheimer's disease, vascular dementia, or other/unspecified dementias. For our primary analyses, we included 5 cohort studies with a total of 183 874 women with and 2 309 705 women without HDP. Pooled analysis found a 38% higher risk of all-cause dementia among women with, versus without, any type of HDP (adjusted hazard ratio, 1.38 [95% CI, 1.18-1.61]; P<0.01). When examining association by HDP and dementia subtypes, we found that women with, versus without, any type of HDP had over a 3-fold higher risk of vascular dementia (adjusted hazard ratio, 3.14 [95% CI, 2.32-4.24]; P<0.01). Our findings indicate that maternal history of HDP is an important risk factor for later development of vascular and all-cause dementia. Further research among more racially/ethnically diverse populations quantifying HDP's effect on all-cause dementia, and specifically vascular dementia, is warranted.

O33 - “I think we should pull together as a team”- Together on the path to the top: Interdisciplinary collaboration in partnership with women on long-term health after hypertensive disorder of pregnancy

Hypertensive disorders of pregnancy (HDP) affect 5-10% of pregnancies and significantly increase a woman’s risk of developing cardiovascular disease, including 2-3 times the risk of heart attack, stroke and diabetes. Long-term risks rise within 10 years after HDP and continue lifelong, making long-term health after HDP of major public health importance. Prior findings suggest evidence to practice gaps in knowledge translation to women about their post-HDP health. To explore Australian women’s and healthcare provider’s (HCP) education and follow-up preferences regarding health after HDP. Focus will be drawn on the role of the midwife within this context. A qualitative study using a framework analysis was undertaken. Women with a history of HDP and HCP who previously completed a survey about long-term health after HDP were invited to participate. Interviews explored participant preferences and priorities concerning knowledge acquisition around long-term health after HDP. Thirteen women and twenty HCP (including 11 midwives) were interviewed. Women’s preference included early post-HDP risk counselling about long-term and mitigable risk factors from their midwife/general practitioner/specialist, accompanied with evidence-based, print or web-based information to take home. HCP wanted access to similar material to assist in their risk discussions with women, as well as professionally endorsed multi-disciplinary education for their own learning. HCP including midwives emphasised all HCP shared responsibility for women’s post-HDP follow-up: “It's everyone’s business… if you have that opportunity, you find out that someone's got that history, you say, ‘Oh, did you know? Has anyone spoken to you about this?” (Midwife). Both women and HCP favoured more structured long-term follow-up to facilitate the transition from hospital to community health. Women and HCP wanted more, easily accessible information about post-HDP health, as well as a more structured transition from hospital to community health post-HDP. This evidence will guide development of post-HDP education.

Associations of hypertensive disorders of pregnancy and gestational diabetes mellitus with menopausal symptoms at midlife in Project Viva.

The aim of this study was to evaluate the associations of a lifetime history of hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) with menopausal symptoms in midlife. This was a secondary analysis of women participating in Project Viva, an ongoing cohort enrolled during pregnancy. The exposure was lifetime history of HDP or GDM assessed for the index pregnancy by review of outpatient and hospital medical records and for all other pregnancies by interview or questionnaire at study entry (1999-2002) and the midlife visit (2017-2021). The primary outcome was the Menopause Rating Scale (MRS) applied at the midlife study visit. We used linear or logistic regression models adjusted for covariates such as baseline age, race/ethnicity, education, married/cohabiting, household income, baseline parity, age at menarche, and body mass index at midlife. Of the 676 included participants, 120 (18%) had a history of HDP, and 47 (7%) had a history of GDM. The mean (SD) age was 52 (3.9) years at the midlife visit, and 48% of the participants had experienced menopause. There were no consistent differences in total, domain-specific, or individual symptoms in women with a history of HDP or GDM. A history of HDP and/or GDM was not associated with age at the onset of natural menopause. Our findings do not support an association of a history of HDP or GDM with the severity of menopausal symptoms or age at the onset of natural menopause. Larger studies of women with a history of these pregnancy complications are needed to clarify their association with menopausal symptoms.

Risk of future cardiovascular diseases in different years postpartum after hypertensive disorders of pregnancy: A systematic review and meta-analysis.

Objective:There are limited data on the optimal timing and frequency of postpartum follow-up visits after hypertensive disorders of pregnancy (HDP) for primary prevention and early detection of cardiovascular diseases (CVDs) in high-risk women. We aimed to evaluate the risk of cardiovascular outcomes later in life in women with prior HDP in different years postpartum and in preeclamptic women with severe features, or early onset of preeclampsia.Methods:We searched MEDLINE, Cochrane Library, Web of Science, and Scopus without language restriction for relevant articles published from inception to March 16, 2022. We included prospective and retrospective cohort studies assessing hypertension, ischemic heart disease, heart failure, venous thromboembolism, peripheral vascular disease, stroke, dementia, composite cardiovascular and/or cerebrovascular diseases, and mortality after 6 weeks postpartum, in women with prior HDP compared with controls. Two authors independently selected and appraised the studies. Article quality was independently assessed using the Newcastle-Ottawa Scale (NOS). Random-effect models were used for meta-analysis. Stratified analyses based on years postpartum, severity, and onset of preeclampsia were performed.Results:We included 59 studies for qualitative review, of which 56 were included in quantitative meta-analysis, involving 1,262,726 women with prior HDP and 14,711,054 controls. Women with prior HDP had increased risks of hypertension (relative risk [RR] 3.46, 95% confidence interval [CI]: 2.67–4.49), ischemic heart disease (RR 2.06, 95% CI: 1.38–3.08), and heart failure (RR 2.53, 95% CI: 1.28–5.00) later in life, compared with those with normotensive pregnancies. The risk of hypertension was highest during 5 years postpartum (RR 5.34, 95% CI: 2.74–10.39). Compared with normotensive pregnancies, the risk of future CVDs significantly increased in preeclamptic women.Discussion:A history of HDP is associated with approximately 2- to 4-fold increase in the risk of CVDs. Screening for CVDs and their risk factors in women with prior HDP since delivery, especially the first 5 years after delivery is suggested for early detection and appropriate management. Evidence on the risks of CVDs in preeclampsia with severe features and early onset of preeclampsia is limited due to having few studies and high heterogeneity.Funding:The Royal Golden Jubilee PhD Program–RGJ (PHD/0183/2561); Thailand Science Research and Innovation (TSRI) Research Career Development Grant–RSA (RSA6180009); Targeted Research Grants Program of the Faculty of Medicine, Prince of Songkla University, Thailand.Registration:CRD42020191550

Is This A Fact? Hypertensive Disorder in 1st Pregnancy Recurs in 2nd Pregnancy

Background: Hypertensive disorder of pregnancy (HDP) entails a risk of recurrence in a subsequent pregnancy. Several risk factors have been associated with recurrence of hypertensive disorder in pregnancy. There is also evidence that the different clinical forms of HDP may be related to each other. Therefore, in HDP studies, it may be preferable to include all clinical forms of the hypertensive disorder not only in the 1st pregnancy, but also in later pregnancies. Aim: To study recurrence of Hypertensive Disorder of Pregnancy in 2nd Pregnancy with regard to the type and time of onset of hypertensive disorder in 1st pregnancy. Methodology: The study was conducted at department of obstetrics &amp; gynecology Lalla Ded Hospital GMC Srinagar. 250 patients with history and maternity records of hypertensive disorder of pregnancy (HDP) in first pregnancy were followed on OPD basis till final outcome of second pregnancy to observe the recurrence of hypertensive disorder in second pregnancy with regard to type of hypertensive disorder and time of onset of hypertensive disorder in first pregnancy. Paired t-test &amp; Chi-square test was used. Recurrence rate of HDP was reported as percentage along with its 95% confidence interval. Two sided p-values were reported and a p-value of &lt;0.05 was considered statistically significant. Results: Out of 250 patients, 142 (56.8%) had gestational hypertension in 1st pregnancy with recurrence of different types of HDP of 101(71.12%) in present pregnancy. 43(17.2%) patients having preeclampsia/eclampsia in 1st pregnancy had recurrence of 25(58.13%) in present pregnancy. 55(22%) patients having Chronic hypertension in 1st pregnancy had recurrence of 49(89.09%) in present pregnancy.7(2.8%) patients diagnosed as having superimposed preeclampsia in 1st pregnancy had recurrence of 6(85.7%). Out of 3(1.2%) patients diagnosed as having HELLP syndrome in 1st pregnancy, the recurrence was 3(100%). Women who had HDP in their 1st pregnancy had a high risk of repeated HDP in the 2nd pregnancy, but not necessarily the same type. This risk was higher if the onset of hypertension in the 1st pregnancy was early (&lt;34 weeks) of gestation and was associated independently with higher age of pregnant women (&gt; 30 years), women belonging to urban areas and family history of HDP. Conclusion: Women who had HDP in their 1st pregnancy had a high risk of repeated HDP in the 2nd pregnancy, but not necessarily the same type. This risk was higher if the onset of hypertension in the 1st pregnancy was early (&lt;34 weeks) of gestation and was associated independently with higher age of pregnant women (&gt; 30 years), women belonging to urban areas, women with family history of HDP and also associated with higher cases of preterm and caesarean section deliveries.

Abstract 075: Sociodemographic And Pregnancy Related Differences In Blood Pressure Phenotypes A Decade Following Pregnancy

Introduction: Hypertensive disorders of pregnancy (HDP) such as preeclampsia are associated with a 3-fold increased risk of chronic hypertension (HTN). Office based measurements alone results in frequent HTN misclassification, prompting the need for out-of-office measurements to ensure proper classification. Hypothesis: We hypothesized that individual and neighborhood level sociodemographic factors and adverse pregnancy outcomes are different within the BP phenotypes of persistent normotension, and sustained, white-coat, masked, and isolated diastolic HTN. Methods: Data were from 401 women who gave birth between 2008 - 2009 and participated in a research study 8-10 years following pregnancy. We determined BP phenotypes by comparing the mean office BP (3 measures) and home BP (13 measures) assessed following research protocols. HTN was defined as BP ≥130/80. Sociodemographic characteristics were age, race, education, adiposity, and perceived stress. Neighborhood characteristics were from the CDC Social Vulnerability Index (i.e., socioeconomic status, household composition, minority status, housing type) measured at the census tract level, with higher values representing greater vulnerability. Chi-square determined differences in BP phenotypes for categorical data, and ANOVA for continuous data, both with Tukey correction. Results: Participants had a mean age of 37.6 (5.9), 15.1 (2.6) years of education, 34.7% (n=155) were Black and 22.8% (n=102) had a history of HDP. BMI and central adiposity were higher in all BP phenotypes compared to the normotensive group. Women with sustained HTN ( 6.2%, n=25) and isolated diastolic HTN (18.2%, n=73,) were more likely to be Black and have a history of HDP. However, only women with isolated diastolic HTN were more likely to have less education and higher stress scores. Compared to the normotensive women, those with masked HTN (n=25, 6.2%) tended to have a history of HDP. The BP phenotype groups did not differ by neighborhood level factors, although there was a trend toward lower neighborhood socioeconomic status among the isolated diastolic and masked HTN groups (p&lt; .10). Conclusion: Isolated diastolic HTN was the most common adverse BP phenotype in this sample of young women, and was more common among Black women and those with a history of HDP. Isolated diastolic HTN may be more prevalent than generally recognized in clinical practice. Research is needed to determine the long-term implications of this phenotype, especially among women with a history of HDP. BP phenotypes differed on individual characteristics and neighborhood socioeconomic status, however, neighborhood characteristics such as violence, air quality, and cohesiveness should be considered in future research. This research was supported by T32HL007560 (PIs: Thurston &amp; Gianaros, Trainee: Scott) and AHA award 16SFRN28930000 (PI: Catov).