Women who develop high blood pressure during pregnancy may be more likely than those who don’t to have heart attacks or strokes decades later, a Norwegian study suggests.
Compared to women with normal blood pressure during every pregnancy, women who developed hypertensive disorders, or high blood pressure, during one or more pregnancies were 57% more likely to have a heart attack or stroke at some point between ages 40 and 70.
“We knew that women who experienced hypertensive disorders in pregnancy have a 2-fold increased risk of cardiovascular disease compared to women without these complications,” said lead study author Eirin Beate Haug of the Norwegian University of Science and Technology in Trondheim.
“From our current study, we learned that most of the excess cardiovascular risk in women who had hypertensive disorders in pregnancy can be explained by higher levels of traditional cardiovascular risk factors, especially blood pressure and BMI,” Haug said by email.
High blood pressure and a high BMI (body mass index, a measure of weight relative to height) explained 77% of the excess risk of events like heart attacks and strokes among women who had hypertensive disorders during pregnancy, researchers report in JAMA Cardiology.
The study followed 23,885 women who had one or more pregnancies before age 40, including 2,199 women who had hypertensive disorders during pregnancy.
A total of 728 women only had “gestational” hypertension, when women who normally don’t have high blood pressure develop it during pregnancy. Gestational hypertension progressed to a more serious and potentially life-threatening version of high blood pressure known as preeclampsia in 1,391 women.
Overall, 1,155 women who never had hypertensive disorders during pregnancy still had events like heart attacks or strokes during the study period.
Compared to women who didn’t have high blood pressure during pregnancy, women who had any type of gestational hypertensive disorder were 64% more likely to have a heart attack between ages 40 and 70. Women with a history of hypertension during pregnancy were also 47% more likely to develop heart failure and 40% more likely to have a stroke.
The risk was even greater for the subset of women who had preeclampsia. They were 78% more likely to have a heart attack, 83% more likely to have heart failure, and 46% more likely to have a stroke between ages 40 and 70 compared to women without pregnancy high blood pressure.
Hypertensive disorders in pregnancy didn’t appear to influence the risk of heart problems after age 70, however.
One limitation of the study is that researchers only had data for hospitalized patients, and it’s possible some women had nonfatal events that were treated in other settings, the study team notes.
Another limitation of the results is that researchers didn’t examine whether women had risk factors for heart disease before they conceived.
Still, the findings suggest that women with a history of hypertensive disorders during pregnancy can minimize their risk of future heart issues by keeping their weight and blood pressure within healthy ranges as they age, said Laura Benschop, a researcher at Erasmus Medical Center in Rotterdam, who wasn’t involved in the study.
“Women should be aware of these cardiovascular risk factors and check their blood pressure and BMI regularly (annually) after pregnancy,” Benschop said by email.
While doctors typically screen for these cardiovascular disease risk factors in older adults, women with high blood pressure during pregnancy develop these risk factors earlier in life than women with normal blood pressure in pregnancy, said Jennifer Stuart, a researcher at Brigham and Women’s Hospital and Harvard Medical School in Boston who wasn’t involved in the study.
“Therefore, it is especially important for these women to regularly see their doctor after pregnancy to monitor their blood pressure, body mass index, glucose, and cholesterol,” Stuart said by email.
SOURCE: bit.ly/2XqFiQv JAMA Cardiology, online June 12, 2019.
