History Of Hypertensive Disorders Of Pregnancy Research Articles

Blood Pressure Variability in Pregnancy: an Opportunity to Develop Improved Prognostic and Risk Assessment Tools.

This review discusses the mortality and morbidity of hypertensive disorders of pregnancy (HDP) and the current diagnostic thresholds. It then explores measurement of variability in blood pressure (BP) during pregnancy as an opportunity to identify women at high risk of cardiovascular disease (CVD) later in life. HDP is known to be associated with increased risk of long-term CVD. Current CVD prognostic tools do not incorporate a history of HDP given a lack of improved risk discrimination. However, HDP diagnostic criteria are currently based on a binary threshold, and there is some evidence for the use of variability in BP throughout gestation as a marker of CVD risk. HDP increases long-term risk of CVD. Future studies investigating changes in diagnostic criteria, including the use of BP variability, may improve long-term CVD risk prediction and be incorporated into future risk assessment tools.

Prevalence and Risk Factors of Hypertensive Disorders in Pregnancy: Case of Mezam Division, NWR Cameroon

Background: Hypertensive disorders of pregnancy (HDP) are a global public health concern both in developed and developing countries. Evidence regarding the risk factors of HDP are limited in Cameroon. The aim of the study was to determine the prevalence and risk factors of HDP in Mezam Division. Methods: A cross sectional study conducted between April-July, 2018 in Mezam Division. Consecutive sampling was used to recruit 1210 pregnant women. Descriptive statistics, chi-square (χ2) test and multivariate logistic regression were used for analysis. Results: The prevalence of HDP was 14.5%; of which 3.4% chronic HTN (CH), 31.8% gestational HTN (GH), 48.3% preeclampsia (PE), 5.7% PE superimpose on CH and 10.8% severe PE. Risk factors of CH were: Family history HTN [Adjusted Odd Ratio (AOR), 95%Confidence Interval (CI): 3.70 (1.7-11.6)], stress [2.80 (1.1-10.9)] and overweight/obese [2.6 (1.3-6.7)]. For GH, Single/separated [2.7 (1.5-4.7)], family history [4.4 (1.5-13.1)], alcohol [2.8 (1.1-5.4)] and previous history of HDP [4.9 (1.5-10.2)] were significant. For PE, overweight/obese [2.7 (1.4-7.1)], previous history of HDP [3.5 (1.6-7.1)], smoking [5.1 (1.3-9.3)], mode of delivery (CS) [3.2 (1.4-6.3)], age at first pregnancy (≥35 years) [7.4 (1.9-28.4)], blood group (AB) [3.3 (1.3-5.9)], gestational age (> 40 weeks) [3.1 (1.3-5.9)] and birth spacing (> 108 months) [4.8 (1.3-61.1)] were significant. Conclusion: There is a significant burden of HDP (14.5%). PE and GH represented the highest followed by severe PE. A number of independent risk factors were identified and will help in screening women at higher risk of HDP.

P3463Cardiometabolic risk factors in women with a history of hypertensive disorders of pregnancy

Abstract Introduction A history of hypertensive disorders of pregnancy (HDP) has the unique potential to identify women at higher risk of future maternal cardiovascular disease (CVD), for whom targeted risk-reduction interventions may be particularly helpful. Purpose The aim of the study was to assess the factors and biomarkers of cardiometabolic risk in women with a history of hypertensive disorders of pregnancy. Methods Cross-sectional study of risk factors and biomarkers of cardiometabolic risk among young women with a history of HDP in comparison with normotensive patients during pregnancy. 117 women were studied: gr. 1 – 33 with a history of HDP, 40 [40–43] years; gr. 2 – 44 without a history of HDP, 39 [32–43] years. The control group consisted of 40 patients, 25 [23–28] years. The time interval after delivery was on average 5 to 19 years. We measured serum glucose, insulin, HOMA-IR, lipids, leptin, adiponectin. Left ventricular mass index (LVMI) was estimated by TTE. Data are presented as M±SD and Me (Q25–Q75). Results Women with HDP more often had hypertension (n=27; 82%), obesity (n=20; 39%) and smoking (n=9; 27%), p1–2,3 <0.05. A higher plasma levels of glucose mmol/L (5.5±0.7 vs 5.2±0.6 and 5.1±0.5), leptin ng/ml (42 [30–50] vs 24 [13–32] and 19 [10–29]) and lower plasma levels of adiponectin were observed in gr.1 vs gr. 2 and controls. Mean value of LVMI (g/m2) was statistically higher in women with HDP vs. without HDP and controls (119.9±23.7 vs 85.9±15.2 and 77.6±11.3), p1–2,3 <0.05. Conclusion It is shown that in women with a history of HDP subsequent changes in carbohydrate and lipid metabolism in combination with arterial hypertension and abdominal obesity, which constitute a cluster of the metabolic syndrome, are revealed after careful examination. These changes are also accompanied by insulin resistance, hyperinsulinemia, adipokine imbalance and more pronounced target organ damage.

Abstract P149: Factors Associated With Future Cardiovascular Disease in Women With Hypertensive Disorders of Pregnancy and Gestational Diabetes

Background and aim: Hypertensive disorders of pregnancy (HDP) and gestational diabetes (GDM) are common complications in pregnancy. The risk of developing premature cardiovascular disease (CVD) is increased in women with a history of these disorders. However, more nuanced risk stratification is needed to identify women who would derive the greatest benefit from early risk reduction. We investigated demographic and clinical factors associated with future CVD in women with a history of HDP or GDM. Method: Women who were aged 15 to 45 years at the time of delivery were identified from among all hospital deliveries in Quebec between 1989 and 2016. Criteria for inclusion in the study were HDP, defined as pre-existing hypertension, gestational hypertension, pre-eclampsia, and superimposed pre-eclampsia, or GDM. Women with HDP or GDM were followed until age 60 years for CVD events, death, or loss to follow-up. CVD events included heart disease, cerebrovascular disease, heart and blood vessel procedures, coronary care unit admission, or mortality prior to age 60 years. We examined the association (hazard ratio, HR; 95% confidence interval, CI) between potential predictor variables and future CVD using Cox proportional hazard regression models. Risk factor variables included sociodemographic, pregnancy-related and perinatal factors recorded at the time of delivery. Results: Hypertension in pregnancy or gestational diabetes occurred in 173,430 (14%) of 1,229,278 women admitted for hospital delivery during the study. CVD events occurred in 3.3% of women with hypertensive disorders of pregnancy or gestational diabetes, of which death occurred in 903 (0.5%) women. The median time to event was 12 years. Neonatal death and stillbirth had the strongest associations with CVD. HRs for CVD were 2.29 (95% CI: 1.62-3.25) for neonatal death vs none, and 2.01 (95% CI: 1.556-2.60) for stillbirth vs none. Maternal age, substance use, low socioeconomic status, tobacco use, and obesity were also associated with increased risk of CVD (Table 1). Conclusion: Future studies should investigate whether these identified factors can reliably predict the risk of CVD and mortality in women with a history of hypertensive disorders of pregnancy and gestational diabetes.

Pregnancy Hypertension and a Commonly Inherited IGF1R Variant (rs2016347) Reduce Breast Cancer Risk by Enhancing Mammary Gland Involution.

Background Terminal duct lobular units (TDLUs) are the anatomic sites of breast cancer initiation, and breast tissue involution resulting in lower TDLU counts has been associated with decreased breast cancer risk. The insulin-like growth factor (IGF) pathway plays a role in breast involution, and systemic changes in this developmental pathway occur with hypertensive disorders of pregnancy (HDP), which have also been associated with lower breast cancer risk, especially in women carrying a functional variant of IGF1R SNP rs2016347. We proposed that this breast cancer protective effect might be explained by increased breast tissue involution. Materials and Methods We conducted a retrospective cohort study utilizing the Komen Tissue Bank, which collects breast tissue core biopsies from women without a history of breast cancer. Eighty white non-Hispanic women with a history of HDP were selected along with 120 nonexposed participants, and after genotyping for rs2016347, TDLU parameters were histologically measured blinded to participant characteristics from fixed biopsy sections. Results Stratified models by HDP status demonstrated that among HDP+ participants, those carrying two T alleles of rs2016347 had a decrease in TDLU counts of 53.2% when compared to those with no T alleles (p=0.049). Trend analysis demonstrated a multiplicative decrease in counts of 31.6% per T allele (p=0.050). Although no statistically significant interaction was seen between HDP status and T alleles, interaction terms showed increasingly negative values reaching a p value of 0.124 for HDP × 2T alleles. Conclusions The observed statistically significant decrease in TDLU counts signifies increased breast epithelial involution in women with prior HDP who inherited the TT genotype of IGF1R SNP rs2016347. The increasing degree of breast involution with greater rs2016347 T allele copy number is consistent with the known progressive reduction in IGF1R expression in breast and other normal tissues.

Association of Conventional Cardiovascular Risk Factors With Cardiovascular Disease After Hypertensive Disorders of Pregnancy

Women with a history of hypertensive disorders of pregnancy (HDP) have higher risk of cardiovascular disease (CVD). It is not known how much of the excess CVD risk in women with a history of HDP is associated with conventional cardiovascular risk factors. To quantify the excess risk of CVD in women with a history of HDP and estimate the proportion associated with conventional cardiovascular risk factors. Prospective cohort study with a median follow-up of 18 years. Population-based cohort of women participating in the Nord-Trøndelag Health Study in Norway. We linked data for 31 364 women from the Nord-Trøndelag Health Study (1984-2008) to validated hospital records (1987-2015), the Cause of Death Registry (1984-2015), and the Medical Birth Registry of Norway (1967-2012). A total of 7399 women were excluded based on selected pregnancy characteristics, incomplete data, or because of emigrating or experiencing the end point before start of follow-up, leaving 23 885 women for study. Data were analyzed between January 1, 2018, and June 6, 2018. Experiencing 1 or more pregnancies complicated by HDP before age 40 years vs only experiencing normotensive pregnancies. We used Cox proportional hazards models to estimate the hazard ratios (HRs) for the association between HDP and CVD. The proportion of excess risk associated with conventional cardiovascular risk factors was estimated using an inverse odds ratio weighting approach. Our study population consisted of 23 885 parous women from Nord-Trøndelag County, Norway. A total of 21 766 women had only normotensive pregnancies, while 2199 women experienced ever having an HDP. From age 40 to 70 years, women with history of HDP had an increased risk of CVD compared with women with only normotensive pregnancies (HR, 1.57; 95% CI, 1.32-1.87) but not at older age (β = 0.98; 95% CI, 0.96-1.00; P for interaction by age = .01). Blood pressure and body mass index were associated with up to 77% of the excess risk of CVD in women with history of HDP, while glucose and lipid levels were associated with smaller proportions. In this study, the risk of excess CVD in women with history of HDP was associated with conventional cardiovascular risk factors, indicating that these risk factors are important targets for cardiovascular prevention in these women.

Hypertensive Disorders of Pregnancy and Subsequent Cardiovascular Disease: Current National and International Guidelines and the Need for Future Research.

Background: It is well-established that hypertensive disorders of pregnancy (HDP) are associated with an increased risk of cardiovascular disease (CVD) in later life. National and International guidelines recognize this but due to a lack of research in this area few details are provided on how best to risk stratify or when and how to monitor these women.Objectives: This article aims to summarize current guidelines in this area in order to raise awareness of need for further research in this important clinical area.Search Strategy: A review of the published literature was carried out in August 2018 using the databases EMBASE and Medline and the websites of professional societies were searched manually using the search terms “pre-eclampsia,” “hypertensive disorders of pregnancy,” “management,” “guidelines,” “long term follow up” and “cardiovascular risk.” Guidelines published in English were included and articles that provided guidance on follow up post-partum of women with HDP.Main Results: The search identified 360 records. Of these, 16 guidelines mentioned the follow up of women with HDP; their reported years ranges from 2010 to 2018. Only 8 (50%) provided some level of recommendation for follow up beyond the immediate post-partum period. These recognized the future risk of CVD to women from HDP and provide detailed recommendations for the management of these conditions during pregnancy and in the immediate post-partum period. Guidelines recommended that women and primary care clinicians are made aware of this risk and some suggest yearly BP monitoring, and at least 5 yearly monitoring of renal functions, urinalysis and lipid profile testing alongside lifestyle modifications and control of CVD risk factors. Guidelines used a combination of meta-analysis, individual cohort studies and expert opinions to inform their recommendations.Conclusions: There is a need for future studies of women with a history of HDP to define their trajectory for the development of CVD and candidate biomarkers in order to develop screening, risk stratification, and preventive measures to reduce the significant CV burden associated with HDP in women.

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

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.

Basal Chronic Villitis and Disorders of the Placental Basal Plate: A Possible Immunological Link Between Hypertensive Disorders of Pregnancy and Morbidly Adherent Placenta.

Hypertensive disorders of pregnancy (HDP) are a common cause for preterm delivery. Prior studies showed that chronic villitis (CV) is associated with intrauterine growth restriction, preeclampsia, intrauterine fetal death, and morbidly adherent placenta (MAP). The authors hypothesize that disorders of the placental basal plate, especially basal chronic villitis (BCV), are associated with HDP. The laboratory information system was queried over 12 years to identify placentas with or without the clinical history of HDP and with or without multifocal/focal CV or BCV. As a control for tissue sampling, a similar search was performed over 5 years for placentas evaluated for MAP. Of 19,683 placentas identified, 14.8% had CV which was in 18.5% and 14.2% of placentas associated with or without HDP, respectively, a significant difference (P < .0001). BCV was present in 6.0% and 3.9% of placentas with or without HDP, respectively, also a significant difference (P < .0001). BCV was more likely than multifocal/focal CV to occur in HDP (32.4% vs 27.4%) when all cases of CV were analyzed (P = .025). Of 221 placentas with MAP, 64% had multifocal/focal CV and 36% had BCV. BCV and CV are more common in placentas with HDP than in normotensive pregnancies. They are also seen in MAP, as supported by another recent study.

Clinical Implications

Clinical Implications

Aspirin reduces long-term stroke risk in women with prior hypertensive disorders of pregnancy.

To determine whether hypertensive disorders of pregnancy (HDP) increased long-term stroke risk in women in the California Teachers Study (CTS), a prospective cohort study, and whether aspirin or statin use modified this risk. CTS participants ≤60 years of age at the time of enrollment in 1995 were followed up prospectively for validated stroke outcomes obtained via linkage with California hospital records through December 31, 2015. We calculated unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the primary outcomes of all stroke and stroke before 60 years of age among those with and without a history of HDP. We tested for interactions (p < 0.2) and performed stratified analyses to assess the risk of the primary outcomes in women with and without self-reported use of aspirin or statins. Of 83,749 women included in the analysis, 4,070 (4.9%) had HDP. Women with prior HDP had increased risk of all stroke (adjusted HR 1.3, 95% CI 1.2-1.4) but no increased risk of stroke before age 60 (adjusted HR 1.2, 95% CI 0.9-1.7). There was an interaction (p = 0.18) between aspirin use and HDP history on risk of stroke before age 60: nonusers of aspirin had higher risk (adjusted HR 1.5, 95% CI 1.0-2.1) while aspirin users did not (adjusted HR 0.8, 95% CI 0.4-1.7). This effect was not seen with statins. After controlling for comorbid conditions, women with prior HDP had increased long-term stroke risk, which was reduced by aspirin use. Randomized trials may be needed to assess whether long-term aspirin use could benefit selected women with a history of HDP.

Periodic Assessment Of Antenatal And Post Natal Serum Endothelin1 and Nitric Oxide Levels In Hypertensive Disorders Of Pregnancy

Introduction: Hypertensive Disorder of Pregnancy (HDP) is an independent risk factor of cardiovascular (CVS) disease with persistent endothelial dysfunction, that occurs after the initial insult during pregnancy and persists post partum postulated to be the pathophysiology. Endothelin-1 (ET-1), a potent vasoconstrictor, has been identified as a pivotal mediator in both essential hypertension and HDP. Disturbances in Nitric Oxide (NO) bioavailability found in endothelial dysfunction may increase susceptibility to cardiovascular diseases such as hypertension. Materials and Methods: Thirty six pregnant women at 30-36 weeks period of gestation from the following categories (i) pregnancy induced hypertension (PIH) (ii) chronic hypertension during pregnancy (CH) and (iii) normal pregnant women (Control). Blood pressure indices measurements and sample collection was done at antepartum (30-36 weeks), post partum (8 weeks and 12 weeks). Endothelin-1 was measured using the Human ET-1 (Endothelin-1) ELISA Kit and serum NO was measured using the Nitric Oxide (total) detection kit. Results: All blood pressure indices were significantly higher in HDP patients compared to control during antenatal and post partum periods. Serum ET-1 was significantly higher in patients with HDP compared to control during antenatal until 3 months post partum. This was accompanied by significantly lower levels of serum NO in HDP patients. Conclusion: ET-1 levels in patients with history of HDP irrespective of post partum blood pressure contributes to persistent endothelial dysfunction.

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

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.

Postpregnancy BMI in the Progression From Hypertensive Disorders of Pregnancy to Type 2 Diabetes.

To study the extent to which BMI after pregnancy adds to the elevated risk of postpregnancy type 2 diabetes in women with a history of hypertensive disorders of pregnancy (HDP) (preeclampsia or gestational hypertension). We used data from the Nurses' Health Study II, a prospective cohort study. In women aged 45-54 years without prior gestational diabetes mellitus, we investigated the interaction between BMI and HDP history on the risk of type 2 diabetes. For clinical and public health relevance, we focused on additive interaction. The main outcome measure was the relative excess risk due to interaction calculated from multivariable Cox proportional hazards models using normal weight as the reference group. In total, 6,563 (11.7%) of 56,159 participants had a history of HDP and 1,341 women developed type 2 diabetes during 436,333 person-years. BMI was a strong risk factor for type 2 diabetes regardless of HDP history. However, there was evidence of an additive interaction between BMI and HDP for the risk of type 2 diabetes (P = 0.004). The attributable proportion of risk due to the interaction ranged from 0.12 (95% CI -0.22, 0.46) in women who were overweight to 0.36 (95% CI 0.13, 0.59) in women with obesity class I. Maintaining a healthy weight may be of even greater importance in women with a history of HDP, compared with other women with a history of only normotensive pregnancies, to reduce midlife risk of type 2 diabetes.

129. Unmet information needs of women with hypertensive disorders of pregnancy: A qualitative analysis of narrative responses from an online patient registry

Introduction Hypertensive disorders of pregnancy (HDP) complicate approximately 10% of pregnancies worldwide. Limited data exists about the information needs of women with HDP. Objective/Hypothesis To identify the information needs of women with HDP. Methods We analyzed retrospective data, covering July 2013 to March 2017, from The Preeclampsia Registry (TPR), an on-line survey hosted by the US-based Preeclampsia Foundation. Participants access and enroll in TPR via social media and web searches. We restricted our analysis to women who self-reported a history of HDP and responded to the open-ended question, ”Is there any information that you could have had at the time of this pregnancy that would have been helpful?” Narrative responses were coded, reconciled, and thematically analysed by multiple coders using an inductive approach. Results Of 3285 participants enrolled during the study period, 898 (27%) completed the survey, self-reported a history of HDP, and responded to the open-ended question. Participants were from the United States (86%) and from 27 other countries. Most participants (85%) were not satisfied with the information they received. About 23% were completely unaware of HDP. Participants specified they needed information about symptoms (25%), causes (9%), and long-term complications (3%) of HDP. They also felt ill-informed about postpartum HDP (4%) including its prevalence, symptoms, and treatment. Among these participants, 60% indicated they were unaware HDP could occur postpartum. Finally, 17% indicated disappointment in the quality of their provider or care received, mostly due to inadequate communication about their symptom experiences and feeling that their illness concerns were dismissed. Discussion Most women with a history of HDP in our analysis were not satisfied with the information they received. Unfamiliarity with HDPs, desire for greater knowledge, and poor provider-patient communication and relationship, present opportunities for patient and provider education.

25. Results of a questionnaire survey on blood pressure management in hypertensive disorders of pregnancy in Aomori prefecture, Japan

Aim To clarify the appropriate management of hypertensive disorder of pregnancy (HDP) and establish a long-term follow-up system for women with HDP after delivery. We investigated issues with HDP management approaches by evaluating blood pressure measurement on medical examination, home blood pressure measurement (HBPM) penetration rate, time of blood pressure examination during labor, and follow-up procedure after delivery in women with HDP. Methods We distributed questionnaires on blood pressure management during pregnancy, at delivery, and after delivery to 53 obstetrics and gynecology departments of professional medical institutions in Aomori prefecture, Japan. Results We retrieved completed questionnaires from 52 institutions, and analyzed responses to questionnaires from pregnant women in 39 institutions. Some institutions reported that antihypertensive medication was begun for mild hypertension (140/90 mmHg); these institutions had set a lower target BP. Only 56% of institutions measured blood pressure after labor pain onset. The postpartum follow-up was carried out not only by obstetric and gynecological clinics, but also by many institutions. However, sufficient education on the risk of recurrence in a subsequent pregnancy and lifestyle guidance were not provided. Conclusions There is little consensus on the timing of antihypertensive medication initiation or the appropriate level of blood pressure control. Labor onset hypertension may have been overlooked. Short-term follow-up of women with HDP was found to be frequently carried out; however, long-term follow-up was not. We will continue to provide the appropriate follow-up duration and approach to women with a history of HDP and to proactively engage in lifestyle interventions with the aim of improving longevity.

Midlife development of type 2 diabetes and hypertension in women by history of hypertensive disorders of pregnancy

BackgroundWomen with history of hypertensive disorders of pregnancy (HDP) are at increased risk of early onset cardiovascular disease and type 2 diabetes (T2D). We aimed to investigate the extent to which HDP is also associated with midlife development of T2D and hypertension above and beyond established risk factors.MethodsWe included parous women who attended population-based structured clinical visits at age 50 and 60 years in Sweden 1991–2013 (N = 6587). Women with prior diabetes mellitus, stroke, or ischemic heart disease at age 50 years were excluded. Data on reproductive history were collected from registries. To study the association between history of HDP and the between-visits development of T2D, hypertension, and clinical risk factors of cardiometabolic disease (body mass index (BMI), blood pressure, and total cholesterol), we utilized multivariable adjusted regression models (logistic, log binomial, and linear regression, respectively). Models included data on outcome risk factors at age 50 years, e.g. BMI, 75 g 2 h oral glucose tolerance test result, and mean arterial pressure, respectively.ResultsBetween ages 50 and 60 years, 5.8% of initially disease-free women developed T2D and 31.6% developed hypertension. History of HDP was associated with increased risk of developing T2D between age 50 and 60 years even when adjusting for risk factors, including BMI, at age 50 years (odds ratio (OR) 1.96, 95% confidence interval (CI) 1.29–2.98). By contrast, the higher risk of developing hypertension observed in women with history of HDP (relative risk (RR) 1.47, 95% CI 1.22–1.78) was attenuated when adjusted for risk factors (RR 1.09, 95% CI 0.94–1.25). Participants with a history of HDP had higher mean BMI and blood pressure at age 50 years, with levels roughly corresponding to those observed at age 60 years in unaffected women.ConclusionsWomen with history of HDP are not only at higher risk of cardiometabolic disease during their reproductive years, but HDP is also associated with midlife T2D development above and beyond established risk factors.

Hypertensive Disorders of Pregnancy and Future Maternal Cardiovascular Risk.

Hypertensive disorders of pregnancy (HDP) complicate 5% to 10% of pregnancies and are increasing with the rising prevalence of cardiometabolic diseases in younger women.1 Normal pregnancy is marked by an initial drop in mean arterial pressure, with an eventual rise in blood pressure (BP) to prepregnancy levels.2 The development of HDP involves a number of factors that result in volume and hemodynamic alterations that fail to adapt to the changes accompanying pregnancy. There are well established associations between HDP and the development of maternal cardiovascular disease (CVD) later in life. Although the associations between preeclampsia and future CVD have long been known, newer evidence suggests that there are also long‐term CVD risks associated with gestational hypertension (GH), although the etiology of GH is thought to be distinct from that of preeclampsia. Whether preeclampsia and GH result as manifestations of already preexisting CVD risk or whether they contribute to the pathogenesis of later CVD development is unclear. A history of HDP has the unique potential to identify women at higher risk of future CVD, for whom targeted risk‐reduction interventions may be particularly helpful. In this review, we discuss the evidence for the long‐ and short‐term risks of maternal CVD associated with HDP, with a focus on preeclampsia and GH. We also outline current recommendations for screening and prevention of CVD in women with a history of HDP and highlight important areas in which additional research is needed.

Annals for Educators - 21 August 2018.

Annals for Educators - 21 August 2018.

Hypertensive disorders of pregnancy and future heart failure risk: A nationwide population-based retrospective cohort study

To assess whether hypertensive disorders of pregnancy (HDP) increased the risk of subsequent heart failure (HF) and identify possible risk factors. A nationwide population-based retrospective cohort study. Incidence of heart failure. Among the 23.3 million individuals registered in the National Health Insurance Research Database in Taiwan, 29,186 patients with HDP and 116,744 matched controls were identified. The overall incidence of HF was greater in the HDP group than it was in the control group (9.83 vs. 1.67 per 10,000 person-years), with a significant incidence rate ratio (IRR = 5.88, 95% confidence interval [CI] 5.84-5.92, p < 0.0001). When stratified by age, parity, gestational age, gestational number, and follow-up years, the IRR for subsequent HF remained significantly higher in the HDP group in all stratifications. Additionally, the Kaplan-Meier analysis indicated that the cumulative incidence rate of HF was higher in the HDP group than it was in the control group. The Cox proportional-hazard model analysis showed that in addition to HDP, single parity, preterm and hypertension were independent risk factors for developing HF. Moreover, HF was more likely to develop within 5 years post-partum. Among patients with a history of HDP, the Cox proportional-hazard model showed that severe forms of HDP and increased HDP occurrences were independently associated with the subsequent development of HF. Patients who have experienced HDP presented an increased risk for developing HF later in life. Moreover, among individuals with a history of HDP, those with severe forms of HDP or recurrent HDP displayed an increased subsequent risk of HF.