First-time
pregnancy complications linked to increased risk of hypertension later in life
Women who
experience complications such as preterm births and preeclampsia
during their first pregnancy are nearly twice more likely than women without
complications to develop high blood pressure later in life — some as quickly as
three years later, according to a new study of more than 4,000 women.
The study “Association
of Adverse Pregnancy Outcomes With Hypertension 2 to 7 Years Postpartum”
was published in the Journal of the American Heart Association on 30th
September 2019.
The study
was funded largely by the National Heart, Lung, and Blood Institute (NHLBI),
part of the National Institutes of Health of U.S. Government.
Researchers
say their findings underscore the need for doctors to focus more aggressively
on knowing the health histories of women—both during their pregnancies to help
prevent adverse outcomes, and afterwards to flag their risks for future
cardiovascular events.
“We used to
think it took years and years to develop high blood pressure,” said study author
David Haas, M.D., a professor of obstetrics and gynecology at
Indiana University School of Medicine, Indianapolis, and a practicing OB/GYN
doctor. “We found that it can occur much sooner than expected…in as little as
three years.”
“The
take-home message for pregnant women is to get prenatal care early, talk to
your obstetric provider about your current health conditions, and make sure
your health is as good as it can be,” Haas said. “For women who had
complications during their first pregnancy, routine health care — watching
blood pressure, weight, and cholesterol— is just as critical.”
Past studies
have shown that adverse pregnancy outcomes — a smaller-than-average baby, a
stillbirth, a preterm delivery, for example — are associated with a high risk for
hypertension, cardiovascular disease, and diabetes in women at younger
ages than those without adverse outcomes. But those studies have relied
on retrospectively-collected data and self-reported reproductive histories.
For the
current study, researchers recruited 4,484 women, of whom 62% are white, 14%
black, 16% Hispanic, 3% Asian, and 5% reported as ‘other.’ The women had an
average age of 27 at their first pregnancy.
The
researchers obtained detailed medical histories of the women two to seven years
after their first pregnancy to see if outcomes in their first pregnancies were
associated with their cardiovascular health.
The
researchers found that 31% of the women with at least one adverse outcome
during their first pregnancy experienced chronic hypertension, while only 17%
of those who did not experience complications developed this condition. The
risk of developing chronic hypertension grew even higher with additional
adverse outcomes, they said.
Haas said that the findings underscore the need for doctors to focus on the health histories of women. “That may mean asking more details about the health history of women during pregnancy. It may mean closer health monitoring and more counseling about possible lifestyle modifications to prevent high blood pressure. A lot of the women tested during this study didn’t have any idea that they had high blood pressure,” he said.
Haas said
researchers plan to study the group further to see how their hypertension risk
changes over an even longer period. Future studies using this group will also
examine whether pregnancy complications increase the risk of obesity and
diabetes. Researchers will also explore whether post-partum cardiovascular risk
can be reduced by diet, exercise, medications, and other interventions.
Victoria Pemberton, R.N., a study co-author and program officer with NHLBI, called the study an important step toward improving women’s health. “This is a well-designed study that prospectively followed a diverse population of women from early pregnancy,” she said. “It further highlights the importance of gathering detailed information about pregnancy outcomes.”
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