RESEARCHERS have found a correlation between hypertensive disorders of pregnancy (HDP) and fatal cardiovascular disease up to a year after birth. Several HDPs cause dangerously high blood pressure, including chronic hypertension, gestational hypertension, pre-eclampsia with and without severe features, superimposed pre-eclampsia and eclampsia, and gestational diabetes. Almost all of these conditions were found to double the risk of fatal cardiovascular disease (CVD) compared to females with normal blood pressure, according to a new study.
Rachel Lee, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA, and team examined pregnancy-related mortality rates for females between 15–54 years of age, from 2010–2018, using the Nationwide Readmissions Database (NRD).
Results demonstrated that, of 33,417,736 hospital deliveries, the rate of HDP was 11.0% (9.4% in 2010, rising to 14.4% in 2018). The pregnancy-associated mortality rate from CVD was 6.4 per 100,000 delivery hospitalisations (n=2,141). Compared to patients with normotension, hazard ratios for CVD-related pregnancy-associated mortality rate increased with HDP severity, reaching over 58-fold for patients with eclampsia. Hazard ratios were also higher for stroke-related mortality (1.2–170.9) than heart disease-related (0.99–39.80) mortality across all HDPs. Aside from gestational hypertension, the increased risks of CVD mortality were evident at delivery, and continued 1 year postpartum for all HDPs.
The team concluded that individuals with HDPs, especially those with pre-existing hypertension, need high-quality continuous care, as heart disease and related cardiac symptoms can often be confused with common symptoms of normal pregnancy. The early identification and treatment of hypertensive disorders is crucial for the prevention of maternal stroke, and therefore, Lee and colleagues emphasised the need for guidelines for ongoing care for up to 1 year after delivery for females with HDP. “Cases of chronic hypertension are rising sharply among people of childbearing age, but optimal treatment strategies remain uncertain,” they added, highlighting the need for change.
Reference
Lee R et al. Pregnancy-associated mortality due to cardiovascular disease: impact of hypertensive disorders of pregnancy. Paediatr Perinat Ep. 2024;38(3):204-15.
