Hypertension in pregnancy linked to long-term cardiovascular health problems

Gestational hypertension appears to contribute to a higher risk of cardiovascular disease (CVD), coronary heart disease (CHD), and heart failure, according to a meta-analysis.

Researchers conducted a systematic search of multiple online databases for studies evaluating the association between gestational hypertension and any cardiovascular event. The search yielded 6,974 studies, out of which 21 were included in the meta-analysis (18 cohort and three nested case-control).

The total study population comprised 3,601,192 women, with 127,913 of these having a history of at least one pregnancy affected by gestational hypertension. Studies were conducted in Europe (n=12) and North America (n=5), as well as in Taiwan (n=2) and Australia (n=1). The duration of follow‐up varied from a median of 4.5 years to a maximum of 73 years. Five studies were deemed to be at high risk of bias, and 10 studies provided risk estimates that were poorly adjusted, based on the Newcastle–Ottawa scale.

Gestational hypertension in the first pregnancy was associated with a greater risk of overall CVD (relative risk [RR], 1.45, 95 percent confidence interval [CI], 1.17–1.80) and CHD (RR, 1.46, 95 percent CI, 1.23–1.73), but not stroke (RR, 1.26, 95 percent CI, 0.96–1.65) and thromboembolic events (RR, 0.88, 95 percent CI, 0.73–1.07).

Specifically, among women with one or more pregnancies affected by gestational hypertension, the risk increase was greater for CVD (RR, 1.81, 95 percent CI, 1.42–2.31), CHD (RR, 1.83, 95 percent CI, 1.33–2.51), and heart failure (RR, 1.77, 95 percent CI, 1.47–2.13), but not stroke (RR, 1.50, 95 percent CI, 0.75–2.99).

The findings have several potential explanations, according to the researchers. First, hypertension in pregnancy may cause lasting damage that contributes to CVD. Second, women who develop hypertension in pregnancy may have a pre‐existing predisposition to CVD, which unmasks itself during pregnancy. 

Women who have had gestational hypertension may benefit from counselling during and/or after pregnancy about their long‐term cardiovascular risk, the researchers added.