Department of Obstetrics and Gynaecology, Erasmus MC, Na 2918, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
Department of Cardiology, Erasmus MC, Na 2918, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
Eur J Epidemiol. 2018 Aug;33(8):763-771. doi: 10.1007/s10654-018-0400-1. Epub 2018 May 19.
To examine associations between hypertensive pregnancy disorders and maternal cardiovascular disease (CVD) in later life. We examined the associations between blood pressure (BP) in pregnancy, gestational hypertension (GH) and preeclampsia (PE) with cardiovascular measurements 6 years after index pregnancy among 4912 women participating in the Generation R Study, the Netherlands. BP, left ventricular mass (LV mass), aortic root diameter (AOD), left atrial diameter, fractional shortening, and carotid-femoral pulse wave velocity (PWV). Early pregnancy systolic and diastolic BP were associated with more adverse maternal cardiovascular measurements and a higher incidence of chronic hypertension 6 years after pregnancy. GH was associated with a higher BP, a higher PWV, a larger AOD and an increased LV mass 6 years after index pregnancy. Compared to previous normotensive pregnancies these women had a sixfold increased risk to develop chronic hypertension after pregnancy (OR 6.6, 95% CI 4.6-9.5). Compared to women with a normotensive pregnancy, women with PE had a higher BP and a higher risk of chronic hypertension (OR 4.5, 95% CI 2.6-7.8) at follow-up. After adjustment for BMI at follow-up in all the analyses on GH, PE and cardiovascular measurements, effect estimates attenuated up to 65%, but remained significant. Both GH and PE are associated with markers of adverse maternal cardiovascular health after pregnancy with an increased risk of chronic hypertension. Women with GH and PE may be offered long-term cardiovascular follow-up incorporated in CVD risk management guidelines.
探讨妊娠高血压疾病与母亲产后心血管疾病（CVD）的关系。方法：我们研究了荷兰 Generation R 研究中 4912 名女性在妊娠后 6 年时，妊娠期间的血压（BP）、妊娠期高血压（GH）和子痫前期（PE）与心血管测量值之间的关系。测量的心血管指标包括 BP、左心室质量（LV 质量）、主动脉根部直径（AOD）、左心房直径、射血分数和颈动脉-股动脉脉搏波速度（PWV）。结果：早期妊娠收缩压和舒张压与产后 6 年时更多不良的母亲心血管测量值和慢性高血压的发生率增加相关。GH 与较高的 BP、较高的 PWV、较大的 AOD 和增加的 LV 质量相关。与之前的正常血压妊娠相比，这些女性在产后发展为慢性高血压的风险增加了六倍（OR 6.6，95%CI 4.6-9.5）。与正常血压妊娠的女性相比，PE 女性在随访时 BP 更高，且慢性高血压的风险更高（OR 4.5，95%CI 2.6-7.8）。在所有关于 GH、PE 和心血管测量值的分析中，调整随访时 BMI 后，效应估计值减弱了 65%，但仍具有统计学意义。GH 和 PE 均与产后不良的母亲心血管健康标志物相关，且慢性高血压的风险增加。对于 GH 和 PE 女性，可考虑进行长期心血管随访，并纳入 CVD 风险管理指南。
