Hypertensive Disorders in Pregnancy Linked To Later Risk of Cardiomyopathy

MedicalResearch.com Interview with:
Ida Behrens, MD
and Heather Boyd PhD
Department of Epidemiology Research
Statens Serum Institut
Copenhagen, Denmark

MedicalResearch.com: What is the background for this study?

Response: Over the past decade, we have begun to realize that a woman’s pregnancy experiences can be a predictor of her future health. Miscarriages, stillbirths and preterm deliveries have all been linked with an increased risk of later cardiovascular disease, as have hypertensive disorders of pregnancy (preeclampsia and gestational hypertension). Women with preeclampsia also have an increased risk of peripartum cardiomyopathy, a rare but serious condition that severely compromises heart function at the end of pregnancy or shortly after delivery. We were interested to find out whether women with preeclampsia or gestational hypertension during one or more pregnancies also had an increased risk of cardiomyopathy later in life.

MedicalResearch.com: What are the main findings?

Response: Using Danish national registers, we followed more than 1 million women with pregnancies between 1978 and 2011 – with an average follow-up of almost 18 years per woman – to see whether women with hypertensive disorders of pregnancy had increased rates of cardiomyopathy later in life, compared with women who only had normotensive pregnancies. We found that the women with hypertensive disorders of pregnancy had a two-fold increased risk of cardiomyopathy later in life. Interestingly, only half of this increase in risk could be linked to chronic hypertension, which is common among women who have previously had a hypertensive disorder of pregnancy. The remaining 50% was not associated with hypertension and could potentially be directly attributable to the woman’s pregnancy experience (or to an underlying cause common to both hypertensive disorders of pregnancy and cardiomyopathy).

MedicalResearch.com: What should clinicians and patients take away from your report?

Response: The American Heart Association recommends cardiovascular disease screening for women with a history of hypertensive disorders of pregnancy. A similar recommendation is not appropriate for cardiomyopathy, as this condition is too rare, even among women who had gestational hypertension or preeclampsia while pregnant. On the other hand, our results suggest that clinicians might want to consider this association (between hypertensive disorders of pregnancy and cardiomyopathy) in the diagnostic workup of women presenting with possible symptoms of heart failure and a history of gestational hypertension or preeclampsia.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Shared underlying mechanisms could explain the association between hypertensive disorders of pregnancy and cardiomyopathy revealed by this epidemiologic study. But to establish this for sure, we need “functional” studies that investigate the biological processes that are dysregulated during preeclamptic pregnancies and link these changes with measures of heart function in affected women during and after pregnancy.

MedicalResearch.com: Is there anything else you would like to add?

Response: Our results provide another piece of evidence showing that hypertensive disorders of pregnancy do not just complicate individual pregnancies but have repercussions for the health of affected women long after delivery.

Citation:

Behrens I, Basit S, Lykke J, et al. Association Between Hypertensive Disorders of Pregnancy and Later Risk of Cardiomyopathy. JAMA. 2016;315(10):1026-1033. doi:10.1001/jama.2016.1869.

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More Medical Research Interviews on MedicalResearch.com

Ida Behrens, MD, & and Heather Boyd PhD (2016). Hypertensive Disorders in Pregnancy Linked To Later Risk of Cardiomyopathy MedicalResearch.com