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Hypertensive Disorders of Pregnancy and Premature Mortality Risk
Quick Takes
- Women with hypertensive disorders of pregnancy (HDP) were at increased risk for all-cause premature mortality (before age 70 years), especially CVD-related deaths.
- Even when controlling for the subsequent development of chronic hypertension, women with HDP were at increased risk of CVD-related premature mortality.
Study Questions:
Are hypertensive disorders of pregnancy (HDP) associated with premature mortality (before age 70 years)?
Methods:
Data from the Nurses’ Health Study II (1989-2017) included 88,395 parous nurses. HDP were defined as self-reported pre-eclampsia or gestational hypertension. The association between HDP and premature mortality were estimated by Cox proportional hazards models, with adjustment for various confounders.
Results:
Overall, 2,387 women died before age 70 years (1,141 related to cancer and 212 related to cardiovascular disease [CVD]). Women with HDP had a hazard ratio (HR) of 1.31 (95% confidence interval [CI], 1.18-1.46) for all-cause premature death and HR of 2.26 (95% CI, 1.67-3.07) for CVD-related premature death. When comparing women with interval development of chronic hypertension, women with HDP and chronic hypertension had higher risk of all-cause premature death (HR, 2.02; 95% CI, 1.75-2.33) than women with HDP alone (without chronic hypertension) (HR, 1.20; 95% CI, 1.02-1.40).
Conclusions:
The authors concluded that the presence of HDP was associated with higher risk of premature mortality, especially CVD-related mortality, even in the absence of chronic hypertension.
Perspective:
While prior studies have shown a strong association between HDP and subsequent chronic hypertension, diabetes, and CVD, the association with premature mortality has been less clear. This large prospective cohort demonstrated that even in the absence of chronic hypertension, women with prior HDP were at increased risk of premature death. Notably, women with HDP in two or more pregnancies and women with low birth weight babies had the highest risk. The authors also reported that women with HDP had a higher risk of death due to infections; nervous system diseases; and respiratory, metabolic, or immune disorders, suggesting there may be additional pathways between HDP and mortality that are independent from CVD. This study reinforces the clinical importance of: 1) the identification of women with prior HDP by asking for an obstetric history, and 2) the comprehensive management of medical comorbidities, especially CVD-related risk factors.
Clinical Topics: Cardiovascular Care Team, Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Prevention, Vascular Medicine, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Hypertension
Keywords: Cardiovascular Diseases, Hypertension, Pregnancy-Induced, Infant, Low Birth Weight, Metabolic Syndrome, Mortality, Premature, Neoplasms, Pre-Eclampsia, Pregnancy, Primary Prevention, Risk Factors, Women
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