title: Induction of labour or expectant monitoring in hypertensive pregnancy disorders at term: do women's postpartum cardiovascular risk factors differ between the two strategies?
abstract: OBJECTIVE
  Cardiovascular disease (CVD) is the leading cause of death in women in the western world. Several studies have described the association between hypertensive pregnancy disorders and CVD in later life. Our aim was to compare postpartum cardiovascular risk factors in women who had a shorter and women who had a longer exposure to endothelial activation during their term hypertensive pregnancy.
  
  
  METHODS
  We studied a subsample of women with pregnancy-induced hypertension or mild preeclampsia at term, who had participated in the randomized HYPITAT trial comparing induction of labour (IOL cohort) (n=110) or expectant monitoring (EM cohort) (n = 91). We assessed, 2.5 years postpartum, cardiovascular risk factors, i.e. blood pressure, anthropometrics, glucose, HbA1C, insulin, HOMA score, total cholesterol, HDL cholesterol, triglycerides, high sensitive CRP, micro-albumin and metabolic syndrome, and compared these risk factors between the induction and expectant groups.
  
  
  RESULTS
  The mean time from randomization to delivery was 3.3 days in the induction group and 10.3 days in the expectant group (p<.001), generating a difference in exposure of 7 days. After a mean follow-up period of 2.5 years, the prevalence of hypertension (IOL 34%; EM 37%, p = .66) and metabolic syndrome (IOL 26%; EM 27%, p = 1.0) was similar in both groups. Furthermore, systolic and diastolic blood pressure, BMI, waist circumference, glucose, HbA1C, insulin, HOMA score, lipids, HsCRP-levels and micro-albumin were all comparable between women who had induction of labour and those who had expectant monitoring.
  
  
  CONCLUSIONS
  In women with hypertensive disorders in pregnancy at term, induction of labour does not affect the clinical and biochemical cardiovascular profile at 2.5 years postpartum.
authors.affiliation: Department of Obstetrics and Gynecology, Medical Center Haaglanden, The Hague, The Netherlands; Department of Obstetrics, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: herwie@mchaaglanden.nl.
authors.forename: Wietske
authors.initials: W
authors.lastname: Hermes
authors.forename: Corine M
authors.initials: CM
authors.lastname: Koopmans
authors.forename: Maria G
authors.initials: MG
authors.lastname: van Pampus
authors.forename: Arie
authors.initials: A
authors.lastname: Franx
authors.forename: Kitty W M
authors.initials: KW
authors.lastname: Bloemenkamp
authors.forename: Joris
authors.initials: J
authors.lastname: van der Post
authors.forename: Martina
authors.initials: M
authors.lastname: Porath
authors.forename: Jouke T
authors.initials: JT
authors.lastname: Tamsma
authors.forename: Ben W
authors.initials: BW
authors.lastname: Mol
authors.forename: Christianne J M
authors.initials: CJ
authors.lastname: de Groot
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005323:Fetal Monitoring; D006801:Humans; D006973:Hypertension / Q000150:complications*; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology*; D007751:Labor, Induced; D024821:Metabolic Syndrome / Q000209:etiology; D049590:Postpartum Period; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D015995:Prevalence; D012307:Risk Factors
keywords: Cardiovascular disease; Cardiovascular risk factors; Gestational hypertension; Induction of labour; Preeclampsia