Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts (J.J.S., L.J.T., E.B.R., D.S., J.W.R.).
Harvard T.H. Chan School of Public Health, Boston Children's Hospital, and Harvard Medical School, Boston, Massachusetts, and Michigan State University, Grand Rapids, Michigan (S.A.M.).
Ann Intern Med. 2018 Aug 21;169(4):224-232. doi: 10.7326/M17-2740. Epub 2018 Jul 3.
Women with a history of hypertensive disorders of pregnancy (HDP) are nearly twice as likely to develop cardiovascular disease (CVD) as those who are normotensive during pregnancy. However, the emergence of CVD risk factors after HDP is less well-understood.
To identify associations between HDP and maternal CVD risk factors and chart the trajectory of risk factor development after pregnancy.
Observational cohort study.
United States.
58 671 parous NHS II (Nurses' Health Study II) participants who did not have CVD or risk factors of interest at baseline.
Women were followed for self-reported physician diagnosis of chronic hypertension and hypercholesterolemia and confirmed type 2 diabetes mellitus (T2DM) from their first birth through 2013; mean follow-up ranged from 25 to 32 years across these end points. Multivariable Cox proportional hazards models estimated hazard ratios (HRs) and 95% CIs, with adjustment for prepregnancy confounders.
Compared with women who were normotensive during pregnancy, those with gestational hypertension (2.9%) or preeclampsia (6.3%) in their first pregnancy had increased rates of chronic hypertension (HRs, 2.8 [95% CI, 2.6 to 3.0] and 2.2 [CI, 2.1 to 2.3], respectively), T2DM (HRs, 1.7 [CI, 1.4 to 1.9] and 1.8 [CI, 1.6 to 1.9], respectively), and hypercholesterolemia (HRs, 1.4 [CI, 1.3 to 1.5] and 1.3 [CI, 1.3 to 1.4], respectively). Although these women were more likely to develop CVD risk factors throughout follow-up, the relative risk for chronic hypertension was strongest within 5 years after their first birth. Recurrence of HDP further elevated risks for all end points.
Participants self-reported HDP.
Women with HDP in their first pregnancy had increased rates of chronic hypertension, T2DM, and hypercholesterolemia that persisted for several decades. These women may benefit from lifestyle intervention and early screening to reduce lifetime risk for CVD.
National Institutes of Health.
患有妊娠高血压疾病（HDP）的女性发生心血管疾病（CVD）的风险几乎是妊娠期间血压正常女性的两倍。然而，HDP 后 CVD 风险因素的出现情况了解得还不够充分。
确定 HDP 与产妇 CVD 风险因素之间的关联，并绘制妊娠后风险因素发展的轨迹。
观察性队列研究。
美国。
58671 名 NHS II（护士健康研究 II）参与者，他们在基线时没有 CVD 或感兴趣的风险因素。
从第一次分娩开始，通过 2013 年，女性通过自我报告的医生诊断慢性高血压和高胆固醇血症以及确诊 2 型糖尿病（T2DM）进行随访；这些终点的平均随访时间范围从 25 到 32 年。多变量 Cox 比例风险模型估计风险比（HRs）和 95%置信区间（CI），并根据孕前混杂因素进行调整。
与妊娠期间血压正常的女性相比，首次妊娠中患有妊娠期高血压（2.9%）或子痫前期（6.3%）的女性慢性高血压（HRs，2.8[95%CI，2.6 至 3.0]和 2.2[CI，2.1 至 2.3]）、T2DM（HRs，1.7[CI，1.4 至 1.9]和 1.8[CI，1.6 至 1.9]）和高胆固醇血症（HRs，1.4[CI，1.3 至 1.5]和 1.3[CI，1.3 至 1.4]）的发生率更高。尽管这些女性在整个随访期间更有可能患上 CVD 风险因素，但首次分娩后 5 年内慢性高血压的相对风险最高。HDP 的再次发生进一步增加了所有终点的风险。
参与者自我报告 HDP。
首次妊娠中患有 HDP 的女性患有慢性高血压、T2DM 和高胆固醇血症的比率较高，这种情况持续了几十年。这些女性可能受益于生活方式干预和早期筛查，以降低终生 CVD 风险。
美国国立卫生研究院。
