Jennifer J. Stuart, ScD; Lauren J. Tanz, ScD; Stacey A. Missmer, ScD; Eric B. Rimm, ScD; Donna Spiegelman, ScD; Tamarra M. James-Todd, PhD; Janet W. Rich-Edwards, ScD
Acknowledgment: The authors thank the reviewers and editors for their helpful comments on an earlier draft of this article.
Grant Support: This research was funded by grant UM1 CA176726 from the National Institutes of Health and was supported by awards from the American Heart Association (12PRE9110014 and 13GRNT17070022). Dr. Stuart was supported by Training Grant T32HL098048 from the National Heart, Lung, and Blood Institute and Training Grant T32HD060454 from the National Institute of Child Health and Human Development. Dr. Tanz was supported by the Ruth L. Kirschstein National Research Service Award (NHLBI F31 HL131222).
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-2740.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol and data set: Not available. Statistical code: Available from Dr. Stuart (e-mail, jstuart@mail.harvard.edu).
Corresponding Author: Jennifer Stuart, ScD, Division of Women's Health, Brigham and Women's Hospital, 1620 Tremont Street, OBC 3-34, Boston, MA 02120; e-mail, jstuart@mail.harvard.edu.
Current Author Addresses: Drs. Stuart, Tanz, and Rich-Edwards: Division of Women's Health, Brigham and Women's Hospital, 1620 Tremont Street, OBC 3-34, Boston, MA 02120.
Dr. Missmer: Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Secchia Center, 15 Michigan Street, NE, Grand Rapids, MI 49503.
Dr. Rimm: Department of Nutrition, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Building II, Room 373a, Boston, MA 02115.
Dr. Spiegelman: Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Kresge Building, Room 802, Boston, MA 02115.
Dr. James-Todd: Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, 14th Floor, Room 1411, Boston, MA 02115.
Author Contributions: Conception and design: J.J. Stuart, S.A. Missmer, E.B. Rimm, D. Spiegelman, J.W. Rich-Edwards.
Analysis and interpretation of the data: J.J. Stuart, L.J. Tanz, D. Spiegelman, J.W. Rich-Edwards.
Drafting of the article: J.J. Stuart.
Critical revision of the article for important intellectual content: J.J. Stuart, L.J. Tanz, S.A. Missmer, E.B. Rimm, D. Spiegelman, T.M. James-Todd, J.W. Rich-Edwards.
Final approval of the article: J.J. Stuart, L.J. Tanz, S.A. Missmer, E.B. Rimm, D. Spiegelman, T.M. James-Todd, J.W. Rich-Edwards.
Statistical expertise: D. Spiegelman.
Obtaining of funding: J.J. Stuart.
Women with a history of hypertensive disorders of pregnancy (HDP) are nearly twice as likely to develop cardiovascular disease (CVD) as those who are normotensive during pregnancy. However, the emergence of CVD risk factors after HDP is less well-understood.
To identify associations between HDP and maternal CVD risk factors and chart the trajectory of risk factor development after pregnancy.
Observational cohort study.
United States.
58 671 parous NHS II (Nurses' Health Study II) participants who did not have CVD or risk factors of interest at baseline.
Women were followed for self-reported physician diagnosis of chronic hypertension and hypercholesterolemia and confirmed type 2 diabetes mellitus (T2DM) from their first birth through 2013; mean follow-up ranged from 25 to 32 years across these end points. Multivariable Cox proportional hazards models estimated hazard ratios (HRs) and 95% CIs, with adjustment for prepregnancy confounders.
Compared with women who were normotensive during pregnancy, those with gestational hypertension (2.9%) or preeclampsia (6.3%) in their first pregnancy had increased rates of chronic hypertension (HRs, 2.8 [95% CI, 2.6 to 3.0] and 2.2 [CI, 2.1 to 2.3], respectively), T2DM (HRs, 1.7 [CI, 1.4 to 1.9] and 1.8 [CI, 1.6 to 1.9], respectively), and hypercholesterolemia (HRs, 1.4 [CI, 1.3 to 1.5] and 1.3 [CI, 1.3 to 1.4], respectively). Although these women were more likely to develop CVD risk factors throughout follow-up, the relative risk for chronic hypertension was strongest within 5 years after their first birth. Recurrence of HDP further elevated risks for all end points.
Participants self-reported HDP.
Women with HDP in their first pregnancy had increased rates of chronic hypertension, T2DM, and hypercholesterolemia that persisted for several decades. These women may benefit from lifestyle intervention and early screening to reduce lifetime risk for CVD.
National Institutes of Health.
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]169:224–232. doi: 10.7326/M17-2740
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© 2019
Published: Ann Intern Med. 2018;169(4):224-232.
DOI: 10.7326/M17-2740
Published at www.annals.org on 3 July 2018
Cardiology, Coronary Risk Factors, Diabetes, Dyslipidemia, Endocrine and Metabolism.
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