Hypertensive disorders in pregnancy and subsequently measured cardiovascular risk factors.
OBJECTIVE
To study the association of hypertensive pregnancy disorders with modifiable risk factors for cardiovascular and metabolic diseases and to estimate the feasibility for early detection and prevention.


METHODS
This was a prospective study of 15,065 women with a first singleton birth between 1967 and 1995, who later participated in a population study that included standardized measurements of blood pressure, serum lipids, and body mass index (BMI).


RESULTS
Women with a history of hypertensive disorders in pregnancy (preeclampsia or gestational hypertension) had higher BMI, higher blood pressure, and unfavorable levels of total cholesterol, low-density lipoprotein cholesterol, and triglycerides. Preeclampsia was associated with substantially higher risk of developing diabetes (odds ratio 3.8, 95% confidence interval [CI] 2.1-6.6), and if the hypertensive disorder occurred in more than one pregnancy, or in a relatively late pregnancy, the associations with later cardiovascular risk factors were substantially stronger. Thus, women with two episodes of preeclampsia were approximately 10 times more likely to use blood pressure medication at follow-up (adjusted odds ratio, 11.6, 95% CI 7.1-26.3), and in women with gestational hypertension in three consecutive pregnancies, systolic pressure was on average 27 mm Hg (95% CI 18-37 mm Hg) higher, and diastolic pressure was 12 mm Hg (95% CI 5-19 mm Hg) higher, compared with women without a history of hypertensive disorders. Adjustment for current body mass index partly attenuated these associations, suggesting that BMI may play an important mediating role.


CONCLUSIONS
Women with a history of hypertensive disorders in pregnancy, and particularly women with recurrent pregnancy disorders, should be candidates for intervention intended to prevent premature cardiovascular disease.


METHODS
II.
Magnussen
Elisabeth B
EB
From the Departments of Public Health, Norwegian University of Science and Technology, Trondheim, Norway; Social Medicine, University of Bristol, Bristol, United Kingdom; and Obstetrics and Gynecology, St. Olavs University Hospital, Trondheim, Norway.
Vatten
Lars J
LJ
Smith
George Davey
GD
Romundstad
Pål R
PR
D000328:Adult; D001794:Blood Pressure; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000517:prevention & control; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D018149:Glucose Intolerance / Q000453:epidemiology; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology*; D008055:Lipids / Q000097:blood; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood
D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D008055:Lipids; D014280:Triglycerides