MedicalResearch.com Interview with:
Jennifer J. Stuart, ScD
Postdoctoral Research Fellow in Reproductive & Cardiovascular Epidemiology
Department of Epidemiology
Harvard T.H. Chan School of Public Health
Division of Women’s Health
Brigham and Women’s Hospital and Harvard Medical School
MedicalResearch.com: What is the background for this study?
Response: Preeclampsia and gestational hypertension are common pregnancy complications involving high blood pressure that develops for the first time during pregnancy and returns to normal after delivery. Approximately 10 to 15% of all women who have given birth have a history of either preeclampsia or gestational hypertension. Previous studies have shown that women with a history of high blood pressure in pregnancy are more likely to develop cardiovascular disease events like heart attack and stroke later in life when compared to women with normal blood pressure in pregnancy. However, what is less clear is to what extent these women are more likely to develop chronic hypertension, diabetes, and high cholesterol and when these risk factors begin to emerge after pregnancy.
We examined this question in a cohort of nearly 60,000 American women who we were able to follow for up to 50 years after their first pregnancy. Previous studies have been limited by small numbers, short follow-up, or a lack of information on shared risk factors, such as pre-pregnancy body mass index, smoking, and family history. This research was conducted within the Nurses’ Health Study II, which collected data on these pre-pregnancy factors in tens of thousands of women over several decades.
MedicalResearch.com: What are the main findings?
Response: Women with a history of preeclampsia or gestational hypertension in their first pregnancy had a 2- to 3-fold higher risk of developing chronic hypertension, a 70% higher risk of diabetes, and a 30% higher risk of high cholesterol than women who had normal blood pressure in pregnancy. These relationships persisted in our study even after accounting for pre-pregnancy information like body mass index, smoking, and family history. We also found that chronic hypertension, diabetes, and high cholesterol developed at an earlier age and sooner after pregnancy in these women. Our data showed that the increased risk emerges shortly after pregnancy in women with preeclampsia or gestational hypertension – particularly for chronic hypertension and high cholesterol. We also found that if a woman has had high blood pressure in more than one pregnancy, her risk for these cardiovascular disease risk factors is even higher.
MedicalResearch.com: What should readers take away from your report?
Response: Women who have had preeclampsia or gestational hypertension are at an increased risk for cardiovascular disease risk factors, including chronic hypertension, type 2 diabetes, and high cholesterol. As recommended by the American Heart Association, doctors should obtain a detailed history of pregnancy complications being sure to capture information on preeclampsia and gestational hypertension. They should also consider screening women who have a history of high blood pressure in pregnancy at regular intervals after pregnancy for cardiovascular disease risk factors.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Preeclampsia and gestational hypertension are common pregnancy complications that can alert women and their health care providers about their future cardiovascular health. Women who have had preeclampsia or gestational hypertension should tell their doctor and adopt a heart healthy diet and lifestyle – just like they would if they had a family history of cardiovascular disease – to delay or possibly even prevent cardiovascular disease risk factor development. Our data suggest that the best time to improve your heart health if you have a history of preeclampsia or gestational hypertension is in the years immediately following the pregnancy. However, since these cardiovascular disease risk factors develop over a lifetime, it is never too late to use this information to improve your heart health and lifestyle.
MedicalResearch.com: Is there anything else you would like to add?
Response: Our results are consistent with and extend previous research in this area. Taken together, these findings suggest that prevention and screening strategies for cardiovascular disease risk factors should be developed and evaluated for women with a history of preeclampsia or gestational hypertension.
Stuart JJ, Tanz LJ, Missmer SA, Rimm EB, Spiegelman D, James-Todd TM, et al. Hypertensive Disorders of Pregnancy and Maternal Cardiovascular Disease Risk Factor Development: An Observational Cohort Study. Ann Intern Med. [Epub ahead of print 3 July 2018]doi: 10.7326/M17-2740
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