title: Earlier Age of Onset of Chronic Hypertension and Type 2 Diabetes Mellitus After a Hypertensive Disorder of Pregnancy or Gestational Diabetes Mellitus.
abstract: A prospective cohort study was conducted to assess the impact of a history of hypertensive disorder of pregnancy (HDP) or gestational diabetes mellitus (GDM) on the risk and age of onset of hypertension, type 2 diabetes mellitus (T2D), and cardiovascular disease (CVD) later in life, independent of hypertension and T2D. Between 1993 and 1997, 22 265 ever-pregnant women were included from the European Prospective Investigation into Cancer and Nutrition-NL study, aged 20 to 70 years at baseline. Details on complications of pregnancy and known hypertension were obtained by questionnaire. Blood pressure was measured at enrollment. Participants were followed for the occurrence of CVD events. Data were analyzed using ANCOVA, multivariable logistic regression, and Cox proportional hazard (with HDP and GDM as time-dependent variables for T2D and CVD) models. At enrollment, women with a HDP reported diagnosis of hypertension 7.7 years earlier (95% confidence interval [CI] 6.9-8.5) and women with GDM reported diagnosis of T2D 7.7 years earlier (95% CI 5.8-9.6) than women without pregnancy complications. After adjustment for potential confounders, HDP was associated with presence of hypertension at enrollment (odds ratio 2.12, 95% CI 1.98-2.28) and onset of CVD later in life (hazard ratio 1.21, 95% CI 1.10-1.32). After including the intermediates hypertension and T2D in the model, the risk of CVD later in life decreased (hazard ratio 1.09, 95% CI 1.00-1.20). GDM was associated with an increased risk of developing T2D later in life (hazard ratio 3.68, 95% CI 2.77-4.90), but not with risk of CVD. HDP and GDM have a substantial impact on the risk of CVD and are potentially important indicators for preventive cardiovascular risk management.
authors.affiliation: From the Division of Woman and Baby, Department of Obstetrics, (K.Y.H., A.F., B.B.v.R., M.A.O.), and Julius Center for Health Sciences and Primary Care (K.Y.H., M.J.C.E., M.W.M.V., M.L.B., Y.T.v.d.S.), University Medical Center Utrecht, Utrecht, The Netherlands; Academic Unit of Human Development and Health, Princess Anne Hospital, University of Southampton, Southampton, United Kingdom (B.B.v.R.); and Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands (J.M.A.B., M.W.M.V.).
authors.forename: Karst Y
authors.initials: KY
authors.lastname: Heida
authors.affiliation: From the Division of Woman and Baby, Department of Obstetrics, (K.Y.H., A.F., B.B.v.R., M.A.O.), and Julius Center for Health Sciences and Primary Care (K.Y.H., M.J.C.E., M.W.M.V., M.L.B., Y.T.v.d.S.), University Medical Center Utrecht, Utrecht, The Netherlands; Academic Unit of Human Development and Health, Princess Anne Hospital, University of Southampton, Southampton, United Kingdom (B.B.v.R.); and Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands (J.M.A.B., M.W.M.V.).
authors.forename: Arie
authors.initials: A
authors.lastname: Franx
authors.affiliation: From the Division of Woman and Baby, Department of Obstetrics, (K.Y.H., A.F., B.B.v.R., M.A.O.), and Julius Center for Health Sciences and Primary Care (K.Y.H., M.J.C.E., M.W.M.V., M.L.B., Y.T.v.d.S.), University Medical Center Utrecht, Utrecht, The Netherlands; Academic Unit of Human Development and Health, Princess Anne Hospital, University of Southampton, Southampton, United Kingdom (B.B.v.R.); and Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands (J.M.A.B., M.W.M.V.).
authors.forename: Bas B
authors.initials: BB
authors.lastname: van Rijn
authors.affiliation: From the Division of Woman and Baby, Department of Obstetrics, (K.Y.H., A.F., B.B.v.R., M.A.O.), and Julius Center for Health Sciences and Primary Care (K.Y.H., M.J.C.E., M.W.M.V., M.L.B., Y.T.v.d.S.), University Medical Center Utrecht, Utrecht, The Netherlands; Academic Unit of Human Development and Health, Princess Anne Hospital, University of Southampton, Southampton, United Kingdom (B.B.v.R.); and Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands (J.M.A.B., M.W.M.V.).
authors.forename: Marinus J C
authors.initials: MJ
authors.lastname: Eijkemans
authors.affiliation: From the Division of Woman and Baby, Department of Obstetrics, (K.Y.H., A.F., B.B.v.R., M.A.O.), and Julius Center for Health Sciences and Primary Care (K.Y.H., M.J.C.E., M.W.M.V., M.L.B., Y.T.v.d.S.), University Medical Center Utrecht, Utrecht, The Netherlands; Academic Unit of Human Development and Health, Princess Anne Hospital, University of Southampton, Southampton, United Kingdom (B.B.v.R.); and Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands (J.M.A.B., M.W.M.V.).
authors.forename: Jolanda M A
authors.initials: JM
authors.lastname: Boer
authors.affiliation: From the Division of Woman and Baby, Department of Obstetrics, (K.Y.H., A.F., B.B.v.R., M.A.O.), and Julius Center for Health Sciences and Primary Care (K.Y.H., M.J.C.E., M.W.M.V., M.L.B., Y.T.v.d.S.), University Medical Center Utrecht, Utrecht, The Netherlands; Academic Unit of Human Development and Health, Princess Anne Hospital, University of Southampton, Southampton, United Kingdom (B.B.v.R.); and Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands (J.M.A.B., M.W.M.V.).
authors.forename: Monique W M
authors.initials: MW
authors.lastname: Verschuren
authors.affiliation: From the Division of Woman and Baby, Department of Obstetrics, (K.Y.H., A.F., B.B.v.R., M.A.O.), and Julius Center for Health Sciences and Primary Care (K.Y.H., M.J.C.E., M.W.M.V., M.L.B., Y.T.v.d.S.), University Medical Center Utrecht, Utrecht, The Netherlands; Academic Unit of Human Development and Health, Princess Anne Hospital, University of Southampton, Southampton, United Kingdom (B.B.v.R.); and Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands (J.M.A.B., M.W.M.V.).
authors.forename: Martijn A
authors.initials: MA
authors.lastname: Oudijk
authors.affiliation: From the Division of Woman and Baby, Department of Obstetrics, (K.Y.H., A.F., B.B.v.R., M.A.O.), and Julius Center for Health Sciences and Primary Care (K.Y.H., M.J.C.E., M.W.M.V., M.L.B., Y.T.v.d.S.), University Medical Center Utrecht, Utrecht, The Netherlands; Academic Unit of Human Development and Health, Princess Anne Hospital, University of Southampton, Southampton, United Kingdom (B.B.v.R.); and Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands (J.M.A.B., M.W.M.V.).
authors.forename: Michiel L
authors.initials: ML
authors.lastname: Bots
authors.affiliation: From the Division of Woman and Baby, Department of Obstetrics, (K.Y.H., A.F., B.B.v.R., M.A.O.), and Julius Center for Health Sciences and Primary Care (K.Y.H., M.J.C.E., M.W.M.V., M.L.B., Y.T.v.d.S.), University Medical Center Utrecht, Utrecht, The Netherlands; Academic Unit of Human Development and Health, Princess Anne Hospital, University of Southampton, Southampton, United Kingdom (B.B.v.R.); and Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands (J.M.A.B., M.W.M.V.). Y.T.vanderSchouw@umcutrecht.nl.
authors.forename: Yvonne T
authors.initials: YT
authors.lastname: van der Schouw
mesh_terms: D000328:Adult; D017668:Age of Onset; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D016640:Diabetes, Gestational / Q000453:epidemiology*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology*; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D011247:Pregnancy; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: cardiovascular diseases; gestational diabetes mellitus; hypertension; preeclampsia; pregnancy; pregnancy complications; pregnancy-induced hypertension