Abstract 12175: Hypertensive Disorders First Identified in Pregnancy Increase Risk for Incident Prehypertension and Hypertension in the Year After Delivery
Introduction: Previous studies indicate thathypertensive disorders in pregnancy, including preeclampsia/eclampsia (PE/E), are significantly associated with type 2 diabetes and cardiovascular disease risk. However, little is known about the effect of these conditions on risk of prehypertension (preHTN) or hypertension (HTN) in the early years after delivery.
Methods: The study population consisted of 10,459 women who had prenatal care and delivered a live singleton neonate at ≥20 weeks gestation at Kaiser Permanente Bellflower Medical Center in 2006-2010. HTN and preHTN in the 1 year prior to and after delivery, demographics and anthropometrics were identified from electronic health records. Women with evidence of HTN (defined as 2 HTN diagnoses (ICD-9 401-405), HTN diagnosis and anti-hypertensive medication, HTN diagnosis and elevated blood pressure (EBP; SBP≥140 or DBP≥90) or 2 consecutive EBPs at separate ambulatory visits) or preHTN (defined as 2 consecutive EBPs (120≤SBP≤139 or 80≤DBP≤89) at separate ambulatory visits) prior to pregnancy were excluded from analysis (n=2,424). Hypertension in pregnancy, including PE/E, was identified by ICD-9 642.3-642.6 and 642.9. Robust Poisson regression was used to test association between any hypertensive disorder or PE/E and the combined outcome of preHTN and HTN identified within 1 year after delivery, adjusting for maternal age, race/ethnicity, parity, prenatal smoking, pre-pregnancy BMI, weight gain and gestational age.
Results: Among 8,035 women who were normotensive prior to pregnancy (76% Hispanic; mean±SD age: 29±6 yrs; mean±SD BMI: 26.6±5.5 kg/m2), 517 (6.4%) had hypertension in pregnancy, of whom 317 (4.0%) had PE/E. Overall, 89 (1.1%) women developed HTN and 1,081 (13.5%) developed preHTN in the first year after delivery. After adjustment for potential confounders, women with any hypertension in pregnancy were 2.11 (95% CI: 1.79-2.49) and those with PE/E were 2.17 (95% CI: 1.78-2.66) times as likely to develop HTN or preHTN, compared to women without hypertension or PE/E in pregnancy, respectively.
Conclusions: Post-partum screening and improved follow-up of women with hypertensive disorders first identified in pregnancy may be necessary to prevent future development of preHTN or HTN.
- © 2013 by American Heart Association, Inc.