Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Jul 12:358:j3078.
doi: 10.1136/bmj.j3078.

Risk of post-pregnancy hypertension in women with a history of hypertensive disorders of pregnancy: nationwide cohort study

Ida Behrens  1 , Saima Basit  1 , Mads Melbye  1 , Jacob A Lykke  2 , Jan Wohlfahrt  1 , Henning Bundgaard  3 , Baskaran Thilaganathan  4 , Heather A Boyd  5
Affiliations

Risk of post-pregnancy hypertension in women with a history of hypertensive disorders of pregnancy: nationwide cohort study

Ida Behrens et al. BMJ. .

Abstract

Objectives To determine how soon after delivery the risk of post-pregnancy hypertension increases in women with hypertensive disorders of pregnancy and how the risk evolves over time.Design Nationwide register based cohort study.Setting Denmark.Populations 482 972 primiparous women with a first live birth or stillbirth between 1995 and 2012 (cumulative incidence analyses), and 1 025 118 women with at least one live birth or stillbirth between 1978 and 2012 (Cox regression analyses).Main outcome measures 10 year cumulative incidences of post-pregnancy hypertension requiring treatment with prescription drugs, and hazard ratios estimated using Cox regression.Results Of women with a hypertensive disorder of pregnancy in a first pregnancy in their 20s, 14% developed hypertension in the first decade post partum, compared with 4% of women with normotensive first pregnancies in their 20s. The corresponding percentages for women with a first pregnancy in their 40s were 32% and 11%, respectively. In the year after delivery, women with a hypertensive disorder of pregnancy had 12-fold to 25-fold higher rates of hypertension than did women with a normotensive pregnancy. Rates in women with a hypertensive disorder of pregnancy were threefold to 10-fold higher 1-10 years post partum and remained twice as high even 20 or more years later.Conclusions The risk of hypertension associated with hypertensive disorders of pregnancy is high immediately after an affected pregnancy and persists for more than 20 years. Up to one third of women with a hypertensive disorder of pregnancy may develop hypertension within a decade of an affected pregnancy, indicating that cardiovascular disease prevention in these women should include blood pressure monitoring initiated soon after pregnancy.

PubMed Disclaimer

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: IB and SB were supported by a grant from the Danish Council for Independent Research; IB also received grant support from the Danish Heart Association; no other support for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

None
Fig 1 Ten year cumulative incidences of hypertension by years since first pregnancy in women with and without a hypertensive disorder of pregnancy, by age at first delivery, Denmark, 1995-2012. Follow-up began in 1995 or three months post partum, whichever came later
None
Fig 2 Hazard ratios for hypertension by severity of hypertensive disorder of pregnancy (if any) in the most recent pregnancy and time since most recent pregnancy, among women with at least one live birth or stillbirth in Denmark, 1978-2012. Hazard ratios compare rates of hypertension among women with severe pre-eclampsia (orange), moderate pre-eclampsia (green), and gestational hypertension (black) in the latest pregnancy with rates of hypertension in women whose most recent pregnancy was normotensive. Follow-up began in 1995 or three months post partum, whichever came later. Hazard ratios are adjusted for maternal age, maternal birth year, and parity (see also supplementary figure 1 for corresponding figure with hypertensive disorders of pregnancy classified by timing of delivery)
None
Fig 3 Hazard ratios for hypertension by history of most severe hypertensive disorder of pregnancy and attained maternal age, among women with at least one live birth or stillbirth in Denmark, 1978-2012. Hazard ratios compare rates of hypertension among women with severe pre-eclampsia (orange), moderate pre-eclampsia (green), and gestational hypertension (black) as their most severe hypertensive disorder of pregnancy (cumulative history over all pregnancies) with rates of hypertension in women whose pregnancies were all normotensive. Follow-up began in 1995 or three months postpartum, whichever came later. Hazard ratios are adjusted for maternal age, maternal birth year, parity, and time since most recent pregnancy
None
Fig 4 Hazard ratios for hypertension by hypertensive disorder of pregnancy sequence in two first pregnancies by number of years since the second pregnancy, among women with at least two live births or stillbirths in Denmark, 1978-2012. Hazard ratios compare rates of hypertension among women with a hypertensive disorder of pregnancy in first pregnancy but not in the second (green), a normotensive first pregnancy followed by a hypertensive disorder of pregnancy in second pregnancy (red), and hypertensive disorders of pregnancy in two successive pregnancies (purple), with rates in women with two successive normotensive pregnancies. Follow-up began in 1995 or 3 months after the second delivery, whichever came later. Hazard ratios are adjusted for maternal age, maternal birth year, and parity
See this image and copyright information in PMC

Comment in

References

    1. Abalos E, Cuesta C, Grosso AL, Chou D, Say L. Global and regional estimates of preeclampsia and eclampsia: a systematic review. Eur J Obstet Gynecol Reprod Biol 2013;170:1-7. 10.1016/j.ejogrb.2013.05.005 pmid:23746796. - DOI - PubMed
    1. American College of Obstetricians and Gynecologists Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013;122:1122-31.pmid:24150027. - PubMed
    1. Bellamy L, Casas J-P, Hingorani AD, Williams DJ. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ 2007;335:974 10.1136/bmj.39335.385301.BE pmid:17975258. - DOI - PMC - PubMed
    1. Lykke JA, Langhoff-Roos J, Sibai BM, Funai EF, Triche EW, Paidas MJ. Hypertensive pregnancy disorders and subsequent cardiovascular morbidity and type 2 diabetes mellitus in the mother. Hypertension 2009;53:944-51. 10.1161/HYPERTENSIONAHA.109.130765 pmid:19433776. - DOI - PubMed
    1. Brown MC, Best KE, Pearce MS, Waugh J, Robson SC, Bell R. Cardiovascular disease risk in women with pre-eclampsia: systematic review and meta-analysis. Eur J Epidemiol 2013;28:1-19. 10.1007/s10654-013-9762-6 pmid:23397514. - DOI - PubMed