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Pregnancy-Induced Hypertension and Risk for Heart Failure
Quick Takes
- In a large, nationwide, retrospective cohort study, the rate of HF in women with pregnancy-induced hypertension was higher compared to normotensive women (HR, 1.8; 95% CI, 1.6-2.0).
- The risk for both ischemic (ICM) and nonischemic cardiomyopathy (NICM) was increased with pregnancy-induced hypertension, and these risks were highest in the first 6 years following pregnancy and persisted thereafter.
- Median time to diagnosis of NICM was 16 years and for ICM was 20 years from 6 months post-partum.
Study Questions:
What is the association between pregnancy-induced hypertension (preg-HTN) among primiparous women and risk of heart failure (HF) stratified as ischemic (ICM) versus nonischemic cardiomyopathy (NICM)?
Methods:
This is a nationwide population-based observational study from Sweden. All births from 1988–2019 were included except triplet or more births. Mothers with pre-existing HF, hypertension, ischemic heart disease, and atrial fibrillation prior to conception were excluded, as were those with peripartum cardiomyopathy within 6 months post-partum. Follow-up started 6 months post-partum. Primary outcomes of interest were HF stratified as ICM or NICM.
Results:
A total of 1,433,268 births in primiparous women were included: 80,293 pregnancies were complicated by preg-HTN. The authors matched 79,334 women with preg-HTN to 396,531 normotensive women. Diagnosis of HF before pregnancy was more common in women with preg-HTN (odds ratio, 1.73). Patients with preg-HTN were more likely to be obese, have diabetes pre-pregnancy, and were more likely to give birth to twins. All pregnancy complications were more common with preg-HTN. Over a median follow-up of 13.2 years, the rate of HF in women with preg-HTN was higher compared to normotensive women (hazard ratio [HR], 1.8; 95% confidence interval [CI], 1.6-2.0). The hazard for developing NICM and ICM was higher after preg-HTN compared with normotensive women (HR, 1.7 and 2.3, respectively). Risk for HF was higher with characteristics for more severe preg-HTN such as preterm delivery before 34 weeks and pregnancies with small for gestational age. Median time to diagnosis of NICM was 16 years and for ICM was 20 years from 6 months post-partum. The incidence of HF was highest in the first 6 years following preg-HTN.
Conclusions:
In a large observational study of primiparous women with preg-HTN, the risk for subsequent ischemic and nonischemic HF was increased, with the highest risk being in the 6 years following pregnancy.
Perspective:
Pregnancy-induced hypertensive disorders complicate 5-10% of all pregnancies. In this study, the authors note a higher risk for subsequent ICM and NICM among primiparous women with preg-HTN compared with normotensive women. This risk was highest in the first 6 years post-partum, and while the risk subsequently declined, it remained elevated at longitudinal follow-up. More severe phenotypes of preg-HTN were associated with a higher risk for subsequent HF. Results of this study suggest that women with preg-HTN constitute a high-risk group and perhaps should be followed more closely for development of HF. Strengths of this study include the large numbers from a nationwide cohort. However, given its retrospective nature only, association can be established but not causation.
Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Vascular Medicine, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Acute Heart Failure, Hypertension
Keywords: Cardiomyopathies, Diabetes Mellitus, Heart Failure, Hypertension, Pregnancy-Induced, Infant, Small for Gestational Age, Myocardial Ischemia, Obesity, Pregnancy, Premature Birth, Primary Prevention, Risk Factors, Twins, Women
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