Life Course Trajectories of Cardiovascular Risk Factors in Women With and Without Hypertensive Disorders in First Pregnancy: The HUNT Study in Norway

Abstract

Background Women with hypertensive pregnancy disorders have adverse levels of cardiovascular risk factors. It is unclear how this adverse risk factor profile evolves during adult life. We compared life course trajectories of cardiovascular risk factors in women with preeclampsia or gestational hypertension in their first pregnancy to normotensive women. Methods and Results We linked information on cardiovascular risk factors from the population-based HUNT (Nord-Trøndelag Health Study) surveys with pregnancy information from the Medical Birth Registry of Norway. Trajectories of cardiovascular risk factors were constructed for 22 308 women with a normotensive first pregnancy; 1092 with preeclampsia, and 478 with gestational hypertension in first pregnancy. Already before first pregnancy, women with preeclampsia in their first pregnancy had higher measures of adiposity, blood pressure, heart rate, and serum lipids and glucose compared with women with a normotensive first pregnancy. After first pregnancy, there was a parallel development in cardiovascular risk factor levels, but women with a normotensive first pregnancy had a time lag of >10 years compared with the preeclampsia group. There were no clear differences in risk factor trajectories between women with gestational hypertension and women with preeclampsia. Conclusions Women with hypertensive pregnancy disorders in their first pregnancy had an adverse cardiovascular risk factor profile before pregnancy compared with normotensive women, and the differences persisted beyond 50 years of age. Hypertensive disorders in pregnancy signal long-term increases in modifiable cardiovascular risk factors, and may be used to identify women who would benefit from early prevention strategies.

Keywords: cardiovascular risk factors; epidemiology; hypertensive disorders of pregnancy; life course.

Figure 1

Flow chart of study population. HUNT indicates Nord‐Trøndelag Health Study.

Figure 2

Life course trajectories of mean systolic blood pressure (A), diastolic blood pressure (B), BMI (C), waist circumference (D), hip circumference (E), and waist‐to‐hip ratio (F) for women with normotensive and preeclamptic first pregnancies. Estimates are adjusted for age at measurement, HUNT survey, highest obtained education level, age at first birth, and ever daily smoking. Covariates are fixed at their means with gaps in the graphs corresponding to the woman's first pregnancy, birth at age 23 years, and a 3‐month postpartum period. BMI indicates body mass index; CI, confidence interval; HUNT, Nord‐Trøndelag Health Study.

Figure 3

Population average predicted probabilities of hypertension (defined as current antihypertensive medication and/or blood pressure ≥140 mm Hg systolic or ≥90 mm Hg diastolic) (A), obesity (defined as a BMI ≥30 kg/m²) (B), and diabetes mellitus (defined as self‐reported diabetes mellitus, nonfasting serum glucose ≥11.1 mmol/L, fasting serum glucose ≥7.0 mmol/L, and/or 2‐hour postload serum glucose ≥11.1 mmol/L) (C) by age in women with normotensive and preeclamptic first pregnancies. Estimates are adjusted for age at measurement, HUNT survey, highest obtained education level, age at first birth, and ever daily smoking. Covariates are fixed at their means with gaps in the graphs corresponding to the woman's first pregnancy, birth at age 23, and a 3‐month postpartum period. BMI indicates body mass index; CI, confidence interval; HUNT, Nord‐Trøndelag Health Study.

Figure 4

Life course trajectories of mean nonfasting serum non‐HDL (A) and HDL (B) cholesterol, triglycerides (C), and glucose (D), resting heart rate (E), and serum CRP (F) for women with normotensive and preeclamptic first pregnancies. Estimates are adjusted for age at measurement, HUNT survey highest obtained education level, age at first birth and ever daily smoking. Analyses of glucose and triglycerides were additionally adjusted for time since last meal. Covariates are fixed at their means with gaps in the graphs corresponding to the woman's first pregnancy, birth at age 23, and a 3‐month postpartum period. CRP is given as geometric mean. CI indicates confidence interval; CRP, C‐reactive protein; HDL, high‐density lipoprotein; HUNT, Nord‐Trøndelag Health Study.