on May 11, 2009
Published online before print May 11, 2009, doi: 10.1161/HYPERTENSIONAHA.109.130765
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Submitted on February 12, 2009
From the Department of Obstetrics (J.A.L., J.L.-R.), Rigshospitalet, Copenhagen, Denmark; Departments of Obstetrics, Gynecology, and Reproductive Medicine (J.A.L., E.F.F., M.J.P.) and Epidemiology and Public Health (E.W.T.), Yale University School of Medicine, New Haven, Conn; Faculty of Health Sciences (J.L.-R.), University of Copenhagen, Copenhagen, Denmark; and the Department of Obstetrics and Gynecology (B.M.S.), School of Medicine, University of Cincinnati, Cincinnati, Ohio. * To whom correspondence should be addressed. E-mail: dr.lykke{at}dadlnet.dk.
Abstract—Minimal data exist concerning the relationship between hypertensive pregnancy disorders and various subsequent cardiovascular events and the effect of type 2 diabetes mellitus on these. In a registry-based cohort study, we identified women delivering in Denmark from 1978 to 2007 with a first singleton (n=782 287) and 2 first consecutive singleton deliveries (n=536 419). The exposures were gestational hypertension and mild and severe preeclampsia. We adjusted for preterm delivery, small for gestational age, placental abruption, and stillbirth and, in a second model, we also adjusted for the development of type 2 diabetes mellitus. The end points were subsequent hypertension, ischemic heart disease, congestive heart failure, thromboembolic event, stroke, and type 2 diabetes mellitus. The risk of subsequent hypertension was increased 5.31-fold (range: 4.90 to 5.75) after gestational hypertension, 3.61-fold (range: 3.43 to 3.80) after mild preeclampsia, and 6.07-fold (range: 5.45 to 6.77) after severe preeclampsia. The risk of subsequent type 2 diabetes mellitus was increased 3.12-fold (range: 2.63 to 3.70) after gestational hypertension and 3.68-fold (range: 3.04 to 4.46) after severe preeclampsia. Women having 2 pregnancies both complicated by preeclampsia had a 6.00-fold (range: 5.40 to 6.67) increased risk of subsequent hypertension compared with 2.70-fold (range: 2.51 to 2.90) for women having preeclampsia in their first pregnancy only and 4.34-fold (range: 3.98 to 4.74) for women having preeclampsia in their second pregnancy only. The risk of subsequent thromboembolism was 1.03-fold (range: 0.73 to 1.45), 1.53-fold (range: 1.32 to 1.77), and 1.91-fold (range: 1.35 to 2.70) increased after gestational hypertension and mild and severe preeclampsia, respectively. Thus, hypertensive pregnancy disorders are strongly associated with subsequent type 2 diabetes mellitus and hypertension, the latter independent of subsequent type 2 diabetes mellitus. The severity, parity, and recurrence of these hypertensive pregnancy disorders increase the risk of subsequent cardiovascular events.
Revised on April 13, 2009
Hypertensive Pregnancy Disorders and Subsequent Cardiovascular Morbidity and Type 2 Diabetes Mellitus in the Mother
Jacob A. Lykke*;
Key words: pregnancy • preeclampsia • diabetes mellitus • ischemia • stroke • vascular diseases • epidemiology