Malek Angela M, Wilson Dulaney A, Turan Tanya N, Mateus Julio, Lackland Daniel T, Hunt Kelly J
Department of Public Health Sciences Medical University of South Carolina Charleston SC.
Department of Neurology Medical University of South Carolina Charleston SC.
J Am Heart Assoc. 2021 Feb;10(5):e018155. doi: 10.1161/JAHA.120.018155. Epub 2021 Feb 23.
Background Pre-pregnancy hypertension and hypertensive disorders of pregnancy (HDP; preeclampsia, eclampsia, gestational hypertension) are major health risks for maternal morbidity and mortality. However, it is unknown if racial/ethnic differences exist. We aimed to determine the impact of HDP and pre-pregnancy hypertension on maternal coronary heart disease, stroke, and mortality risk ≤1, 3, and 5 years post-delivery and by race/ethnicity ≤5 years. Methods and Results This retrospective cohort study included women aged 12 to 49 years with a live, singleton birth between 2004 to 2016 (n=254 491 non-Hispanic White; n=137 784 non-Hispanic Black; n=41 155 Hispanic). Birth and death certificates and ( and ) diagnosis codes in hospitalization/emergency department visit data defined HDP, pre-pregnancy hypertension, incident coronary heart disease and stroke, and all-cause mortality. During at least 1 pregnancy of the 433 430 women, 2.3% had pre-pregnancy hypertension with superimposed HDP, 15.7% had no pre-pregnancy hypertension with HDP, and 0.4% had pre-pregnancy hypertension without superimposed HDP, whereas 81.6% had neither condition. Maternal deaths from coronary heart disease, stroke, and all causes totaled 2136. Within 5 years of delivery, pre-pregnancy hypertension, and HDP were associated with all-cause mortality (hazard ratio [HR], 2.21; 95% CI, 1.61-3.03), incident coronary heart disease (HR, 3.79; 95% CI, 3.09-4.65), and incident stroke (HR, 3.10; 95% CI, 2.09-4.60). HDP alone was related to all outcomes. Race/ethnic differences were observed for non-Hispanic Black and non-Hispanic White women, respectively, in the associations of pre-pregnancy hypertension and HDP with all-cause mortality within 5 years of delivery (HR, 2.34 [95% CI, 1.58-3.47]; HR, 2.11 [95% CI, 1.23-3.65]; interaction=0.001). Conclusions Maternal cardiovascular outcomes including mortality were increased ≤5 years post-delivery in HDP, pre-pregnancy hypertension, or pre-pregnancy hypertension with superimposed HDP. The race/ethnic interaction for all-cause mortality ≤5 years of delivery warrants further research.
孕前高血压和妊娠期高血压疾病（HDP；先兆子痫、子痫、妊娠期高血压）是孕产妇发病和死亡的主要健康风险。然而，种族/族裔差异是否存在尚不清楚。我们旨在确定HDP和孕前高血压对产后1年、3年和5年内孕产妇冠心病、中风及死亡风险的影响，并按种族/族裔划分在5年内的影响。
这项回顾性队列研究纳入了2004年至2016年间年龄在12至49岁之间、单胎活产的妇女（n = 254491名非西班牙裔白人；n = 137784名非西班牙裔黑人；n = 41155名西班牙裔）。出生和死亡证明以及住院/急诊科就诊数据中的诊断代码定义了HDP、孕前高血压、新发冠心病和中风以及全因死亡率。在433430名妇女的至少1次妊娠期间，2.3%患有孕前高血压合并HDP，15.7%没有孕前高血压但患有HDP，0.4%患有孕前高血压但无合并HDP，而81.6%两者均无。冠心病、中风和所有原因导致的孕产妇死亡共计2136例。在分娩后5年内，孕前高血压和HDP与全因死亡率（风险比[HR]，2.21；95%置信区间[CI]，1.61 - 3.03）、新发冠心病（HR，3.79；95% CI，3.09 - 4.65）和新发中风（HR，3.10；95% CI，2.09 - 4.60）相关。单独的HDP与所有结局相关。在分娩后5年内，非西班牙裔黑人和非西班牙裔白人妇女在孕前高血压和HDP与全因死亡率的关联中分别观察到种族/族裔差异（HR，2.34 [95% CI，1.58 - 3.47]；HR，2.11 [95% CI，1.23 - 3.65]；交互作用 = 0.001）。
HDP、孕前高血压或孕前高血压合并HDP的产妇在分娩后5年内包括死亡率在内的心血管结局增加。分娩后5年内全因死亡率的种族/族裔交互作用值得进一步研究。
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