Early Mortality, Cardiovascular, and Renal Diseases in Women's Lives Following Hypertensive Disorders of Pregnancy: The Prospective Nationwide Study CONCEPTION

Abstract

Background: We aimed to evaluate the impact of hypertensive disorders of pregnancy occurrence, recurrence, onset time, and severity on mortality and on a wide range of cardiovascular outcomes in France.

Methods and results: CONCEPTION (Cohort of Cardiovascular Diseases in Pregnancy) is a French nationwide prospective cohort using data from the National Health Data System. We included all women in CONCEPTION with no history of a cardiovascular event who delivered in France for the first time between 2010 and 2018 (N=2 819 655). Hypertensive disorders of pregnancy and cardiovascular outcomes during the study follow-up were identified using algorithms combining International Classification of Diseases, Tenth Revision (ICD-10) coded diagnoses during hospitalization and purchases of medication between 2010 and 2021. We fitted Cox models with time-varying exposure to assess the associations of hypertensive disorders of pregnancy with mortality and cardiovascular events. Women with gestational hypertension had a 1.25- to 2-fold higher risk of stroke, acute coronary syndrome, peripheral arterial disease, pulmonary embolism, and chronic kidney disease, and a 2- to 4-fold higher risk of rhythm and conduction disorder and heart failure. Women with preeclampsia had a 1.35- to 2-fold higher risk of rhythm or conduction disorder and pulmonary embolism during follow-up; a 2- to 4-fold higher risk of stroke, acute coronary syndrome, and peripheral arterial disease; and a 7- to 9-fold higher risk of heart failure and chronic kidney disease. They were 1.8 times more likely to die and 4.4 times more likely to die of cardiovascular causes.

Conclusions: Hypertensive disorders of pregnancy drastically increase the risk of mortality, cardiovascular, and renal events early after pregnancy. Recurrent, severe, and early-onset preeclampsia further increases this risk.

Keywords: cardiovascular diseases; cardiovascular risk factors; epidemiology; gestational hypertension; hypertensive disorders of pregnancy; preeclampsia.

Figure 1. Study flowchart.

CONCEPTION indicates Cohort of Cardiovascular Diseases in Pregnancy.

Figure 2. Adjusted hazard ratios of cardiovascular events according to gestational hypertension or PE and its recurrence.

All models were adjusted for diabetes history, social deprivation, obesity, and tobacco use. Maternal age was used as the time scale. Exposures were treated as time‐varying variables. *The follow‐up time was censored at December 31, 2017 in models analyzing cardiovascular death, because causes of death were available only for the 2010 to 2017 period. GH indicates gestational hypertension; and PE, preeclampsia.

Figure 3. Adjusted hazard ratios of cardiovascular events according to the severity and earliness of PE and its association with SGA infant and chronic hypertension.

All models were adjusted for diabetes history, social deprivation, obesity, and tobacco use. Maternal age was used as the time scale. Exposures were treated as time‐varying variables. Models explain PE with/without SGA infant. Birth weight was available only for singleton births between 2013 and 2018. The follow‐up time was censored at December 31, 2017 in models explaining cardiovascular death, because causes of death were available only for the 2010 to 2017 period. HT indicates hypertension; PE, preeclampsia; and SGA, small for gestational age.