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. 2020 Jan;135(1):27-35.
doi: 10.1097/AOG.0000000000003567.

Expectant Management of Hypertensive Disorders of Pregnancy and Future Cardiovascular Morbidity

Joshua I Rosenbloom  1 , Adam K Lewkowitz, Kathryn J Lindley, D Michael Nelson, George A Macones, Alison G Cahill, Margaret A Olsen, Molly J Stout
Affiliations

Expectant Management of Hypertensive Disorders of Pregnancy and Future Cardiovascular Morbidity

Joshua I Rosenbloom et al. Obstet Gynecol. 2020 Jan.

Abstract

Objective: To test the hypothesis that a longer length of time between diagnosis of hypertensive disorders of pregnancy and delivery is associated with increased risk of cardiovascular morbidity in the years after delivery.

Methods: This is a retrospective cohort study based in the New York State Inpatient Database. The first delivery for all patients from 2005 to 2014 who delivered preterm with an International Classification of Diseases, 9th Revision, Clinical Modification code for hypertensive disorders of pregnancy (excluding isolated chronic hypertension) was included. The duration between diagnosis and delivery was divided into 7 days or less or more than 7 days. The primary outcome was admission for a composite of cardiovascular disease, stroke, or death after the index delivery through December 31, 2014.

Results: There were 22,594 patients with a median follow-up period of 5.2 years: 19,750 (87.4%) were delivered within 7 days of diagnosis and 2,844 (12.6%) were delivered more than 7 days from diagnosis. The primary outcome occurred in 216 (1.1%) patients in the 0-7 days group (21 events/10,000 person-years) and 67 (2.4%) patients in the more than 7 days group (46 events/10,000 person-years), adjusted hazard ratio 1.45 (95% CI 1.09 to 1.93). The findings were robust in a number of sensitivity analyses.

Conclusions: Prolonged expectant management of preterm hypertensive disorders of pregnancy is associated with an increased risk of maternal cardiac disease in the ensuing years.

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Conflict of interest statement

Financial Disclosure

Margaret A. Olsen disclosed that money has been paid to her institution from Pfizer, Merck, and Sanofi Pasteur. The other authors did not report any potential conflicts of interest.

Figures

Figure 1:
Figure 1:
Study flow diagram. *Due to restrictions on presentation of results from the Healthcare Cost and Utilization Project data, any counts <11 are reported as “<11” to preserve patient privacy.
Figure 2:
Figure 2:
Time-to-event curves for cardiovascular readmission or death. Patients with a lag >7 days from diagnosis of a hypertensive disorder of pregnancy to delivery (red) had an increased risk of death or cardiovascular admission in the years after delivery compared to patients who were delivered within 7 days (blue).
See this image and copyright information in PMC

Comment in

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