10: Hypertensive disorders in pregnancy, recurrence in a second pregnancy, and subsequent cardiovascular events


      Hypertensive pregnancy disorders have been associated with subsequent death and ischemic heart disease. Minimal data exists concerning the relationship between hypertensive pregnancy disorders, other subsequent cardiovascular events or type 2 diabetes mellitus.

      Study Design

      We conducted a registry based retrospective cohort study of women giving birth in Denmark from 1978 to 2007. A cohort of 782,287 women having a first singleton delivery was followed for 14.6 years yielding 11,600,945 person-years; and a cohort of 536,419 women having two first deliveries of singletons was followed for 12.9 years yielding 6,990,836 person-years.The primary exposure was hypertensive disorders in pregnancy stratified into gestational hypertension, mild and severe preeclampsia. Endpoints were subsequent hypertension, ischemic heart disease, congestive heart failure, thromboembolic event, stroke, and type 2 diabetes mellitus. We used time-to-first event using the Cox proportional hazard model to calculate the associations.


      The adjusted hazard ratio of subsequent hypertension was 5.12 (4.73-5.54) after gestational hypertension, 3.52 (3.34-3.71) for mild preeclampsia, and 6.36 (5.72-7.09) for severe preeclampsia. The adjusted hazard ratio of subsequent type 2 diabetes mellitus was 3.5 (p<0.001) after any type of hypertensive disorder in pregnancy. The adjusted hazard ratio of subsequent thromboembolism after gestational hypertension was 1.02 (0.73-1.41), and 1.48 (1.28-1.71) and 1.59 (1.22-2.08) after mild and severe preeclampsia, respectively. Women having at least two pregnancies both complicated by preeclampsia had an adjusted hazard ratio of subsequent hypertension of 5.92 (5.32-6.59) compared to 2.69 (2.50-2.89) for women having preeclampsia in their first pregnancy only, and 4.14 (3.79-4.52) in their second pregnancy only.


      Hypertensive disorders in pregnancy are strongly associated with subsequent hypertension and type 2 diabetes mellitus. The severity and recurrence of these pregnancy complications increase the risk of subsequent cardiovascular events.