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. 2020 Nov;76(5):1506-1513.
doi: 10.1161/HYPERTENSIONAHA.120.15654. Epub 2020 Aug 24.

Heart Failure in Women With Hypertensive Disorders of Pregnancy: Insights From the Cardiovascular Disease in Norway Project

Michael C Honigberg  1   2   3   4   5 , Hilde Kristin Refvik Riise  6 , Anne Kjersti Daltveit  7 , Grethe S Tell  7   8 , Gerhard Sulo  7 , Jannicke Igland  7 , Kari Klungsøyr  7   8 , Nandita S Scott  1   2   3 , Malissa J Wood  1   2   3 , Pradeep Natarajan  1   4   5 , Janet W Rich-Edwards  9   10
Affiliations

Heart Failure in Women With Hypertensive Disorders of Pregnancy: Insights From the Cardiovascular Disease in Norway Project

Michael C Honigberg et al. Hypertension. 2020 Nov.

Abstract

Hypertensive disorders of pregnancy (HDP) have been associated with heart failure (HF). It is unknown whether concurrent pregnancy complications (small-for-gestational-age or preterm delivery) or recurrent HDP modify HDP-associated HF risk. In this cohort study, we included Norwegian women with a first birth between 1980 and 2004. Follow-up occurred through 2009. Cox models examined gestational hypertension and preeclampsia in the first pregnancy as predictors of a composite of HF-related hospitalization or HF-related death, with assessment of effect modification by concurrent small-for-gestational-age or preterm delivery. Additional models were stratified by final parity (1 versus ≥2 births) and tested associations with recurrent HDP. Among 508 422 women, 565 experienced incident HF over a median 11.8 years of follow-up. After multivariable adjustment, gestational hypertension in the first birth was not significantly associated with HF (hazard ratio, 1.41 [95% CI, 0.84-2.35], P=0.19), whereas preeclampsia was associated with a hazard ratio of 2.00 (95% CI, 1.50-2.68, P<0.001). Among women with HDP, risks were not modified by concurrent small-for-gestational-age or preterm delivery (Pinteraction=0.42). Largest hazards of HF were observed in women whose only lifetime birth was complicated by preeclampsia and women with recurrent preeclampsia. HF risks were similar after excluding women with coronary artery disease. In summary, women with preeclampsia, especially those with one lifetime birth and those with recurrent preeclampsia, experienced increased HF risk compared to women without HDP. Further research is needed to clarify causal mechanisms.

Keywords: gestational age; heart failure; hypertension; pre-eclampsia; pregnancy; women.

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Conflict of interest statement

Conflict of interest: P.N. reports grant support from Amgen, Apple, and Boston Scientific, as well as consulting income from Apple, all unrelated to this work. All remaining authors have no conflict of interest.

Figures

Figure 1.
Figure 1.
Creation of the study cohort.
Figure 2.
Figure 2.
Kaplan-Meier curves for heart failure-free survival by hypertensive disorder of pregnancy status in the first birth. HDP = hypertensive disorder of pregnancy; GH = gestational hypertension; PE = preeclampsia Mean (SD) maternal age at the start of follow-up is 30.3 (4.8) years for women with no HDP, 30.8 (4.7) years for women with gestational hypertension, and 30.3 (4.8) years for preeclampsia in the first pregnancy
Figure 3.
Figure 3.
Kaplan-Meier curves for heart failure-free survival (A) by hypertensive disorder of pregnancy status among one-child mothers and (B) by recurrent hypertensive disorder of pregnancy status among women with ≥2 lifetime births. HDP = hypertensive disorder of pregnancy; GH = gestational hypertension; PE = preeclampsia Mean (SD) maternal age at the start of follow-up is 27.6 (5.8) years for one-child mothers with no HDP, 29.0 (5.9) years for one-child mothers with GH, 28.1 (5.9) years for one-child mothers with PE, 30.8 (4.4) years in women with ≥2 births and no HDP, 31.5 (4.4) years in women with GH in ≥1 birth and no PE, 31.1 (4.4) years in women with ≥2 births and 1 PE episode, and 31.5 (4.4) years in women with PE in ≥2 births
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References

    1. Levine RJ, Maynard SE, Qian C, Lim KH, England LJ, Yu KF, Schisterman EF, Thadhani R, Sachs BP, Epstein FH, Sibai BM, Sukhatme VP, Karumanchi SA. Circulating angiogenic factors and the risk of preeclampsia. N Engl J Med. 2004;350(7):672–83. - PubMed
    1. LifeCycle Project-Maternal Obesity and Childhood Outcomes Study Group, Voerman E, Santos S, Inskip H, Amiano P, Barros H, Charles MA, Chatzi L, Chrousos GP, Corpeleijn E, Crozier S, Doyon M, Eggesbø M, Fantini MP, Farchi S, Forastiere F, Georgiu V, Gori D, Hanke W, Hertz-Picciotto I, Heude B, Hivert MF, Hryhorczuk D, Iñiguez C, Karvonen AM, Küpers LK, Lagström H, Lawlor DA, Lehmann I, Magnus P, Majewska R, Mäkelä J, Manios Y, Mommers M, Morgen CS, Moschonis G, Nohr EA, Nybo Andersen AM, Oken E, Pac A, Papadopoulou E, Pekkanen J, Pizzi C, Polanska K, Porta D, Richiardi L, Rifas-Shiman SL, Roeleveld N, Ronfani L, Santos AC, Standl M, Stigum H, Stoltenberg C, Thiering E, Thijs C, Torrent M, Trnovec T, van Gelder MMHJ, van Rossem L, von Berg A, Vrijheid M, Wijga A, Zvinchuk O, Sørensen TIA, Godfrey K, Jaddoe VWV, Gaillard R. Association of Gestational Weight Gain With Adverse Maternal and Infant Outcomes. JAMA. 2019;321(17):1702–15. - PMC - PubMed
    1. Wu P, Haththotuwa R, Kwok CS, Babu A, Kotronias RA, Rushton C, Zaman A, Fryer AA, Kadam U, Chew-Graham CA, Mamas MA. Preeclampsia and Future Cardiovascular Health: A Systematic Review and Meta-Analysis. Circ Cardiovasc Qual Outcomes. 2017;10(2). - PubMed
    1. Leon LJ, McCarthy FP, Direk K, Gonzalez-Izquierdo A, Prieto-Merino D, Casas JP, Chappell L. Preeclampsia and Cardiovascular Disease in a Large UK Pregnancy Cohort of Linked Electronic Health Records: A CALIBER Study. Circulation. 2019;140(13):1050–60. - PubMed
    1. Männistö T, Mendola P, Vääräsmäki M, Järvelin MR, Hartikainen AL, Pouta A, Suvanto E. Elevated blood pressure in pregnancy and subsequent chronic disease risk. Circulation. 2013;127(6):681–90. - PMC - PubMed

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