Malek Angela M, Wilson Dulaney A, Mateus Julio, Ash Emily A, Turan Tanya N, Lackland Daniel T, Hunt Kelly J
Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA.
Department of Obstetrics & Gynecology, Maternal-Fetal Medicine Division, Atrium Health, Charlotte, NC, 28204, USA.
Cardiovasc Diabetol. 2025 Jul 11;24(1):282. doi: 10.1186/s12933-025-02811-8.
Pre-pregnancy hypertension (HTN), hypertensive disorders of pregnancy (HDP), and diabetes have been linked to increased risk of post-pregnancy coronary heart disease (CHD) and all-cause mortality, but few studies have investigated their cumulative impact. This study aimed to assess the potential relationship between pre-pregnancy HTN, HDP, and diabetes and their cumulative impact on maternal cardiovascular outcomes defined as incident CHD and all-cause mortality within 5 years of delivery and over the entire study period (up to 14 years after delivery).
This retrospective cohort study included 430,545 women aged 12-49 with ≥ 1 singleton, live birth in South Carolina (2004-2016) including non-Hispanic White (NHW; 59.2%), non-Hispanic Black (NHB; 31.4%), and Hispanic (9.4%) women. Birth certificate and hospitalization/emergency department (ED) visit data defined pre-pregnancy HTN, HDP (preeclampsia, eclampsia, gestational HTN), and diabetes (pre-pregnancy, gestational). Hospitalization/ED visit and death certificate data defined incident CHD and all-cause mortality. Covariate-adjusted Cox proportional hazard models were used to assess associations between CHD and mortality by exposure.
After adjustment for covariates relative to women without any of the three conditions (diabetes, pre-pregnancy HTN, HDP), incident CHD risk was increased within 5 years of delivery for women with diabetes (HR = 1.57; 95% CI 1.28-1.92), HDP (HR = 1.85; 95% CI 1.60-2.15), HDP and diabetes (HR = 2.29; 95% CI 1.73-3.03), HDP and pre-pregnancy HTN (HR = 3.13; 95% CI 2.66-3.68), and all three conditions (HR = 4.87; 95% CI 3.95-6.01). All-cause mortality risk was increased for diabetes (HR = 1.34; 95% CI 1.01-1.78), HDP and pre-pregnancy HTN (HR = 1.53; 95% CI 1.15-2.03), and all three conditions (HR = 2.25; 95% CI 1.51-3.36), but not HDP or HDP and diabetes.
Within 5 years of delivery, incident CHD and all-cause mortality rates were highest for women with two or three conditions, specifically HDP, diabetes, and/or pre-pregnancy HTN, with all rates higher for NHB than NHW women. Thus, it is critical to implement clinical prevention strategies to improve risk factor screening and identification among women of child-bearing age.
孕前高血压（HTN）、妊娠期高血压疾病（HDP）和糖尿病与产后冠心病（CHD）风险增加及全因死亡率升高有关，但很少有研究调查它们的累积影响。本研究旨在评估孕前HTN、HDP和糖尿病之间的潜在关系，以及它们对孕产妇心血管结局的累积影响，该结局定义为分娩后5年内及整个研究期间（分娩后长达14年）的新发CHD和全因死亡率。
这项回顾性队列研究纳入了430,545名年龄在12 - 49岁之间、在南卡罗来纳州（2004 - 2016年）有≥1次单胎活产的女性，包括非西班牙裔白人（NHW；59.2%）、非西班牙裔黑人（NHB；31.4%）和西班牙裔（9.4%）女性。出生证明和住院/急诊科（ED）就诊数据定义了孕前HTN、HDP（先兆子痫、子痫、妊娠期HTN）和糖尿病（孕前、妊娠期）。住院/ED就诊和死亡证明数据定义了新发CHD和全因死亡率。采用协变量调整的Cox比例风险模型来评估CHD和死亡率与暴露因素之间的关联。
在对无这三种疾病（糖尿病、孕前HTN、HDP）的女性进行协变量调整后，糖尿病女性在分娩后5年内发生CHD的风险增加（HR = 1.57；95% CI 1.28 - 1.92），HDP女性（HR = 1.85；95% CI 1.60 - 2.15），HDP合并糖尿病女性（HR = 2.29；95% CI 1.73 - 3.03），HDP合并孕前HTN女性（HR = 3.13；95% CI 2.66 - 3.68），以及三种疾病都有的女性（HR = 4.87；95% CI 3.95 - 6.01）。糖尿病女性（HR = 1.34；95% CI 1.01 - 1.78）、HDP合并孕前HTN女性（HR = 1.53；95% CI 1.15 - 2.03）以及三种疾病都有的女性（HR = 2.25；95% CI 1.51 - 3.36）的全因死亡风险增加，但HDP女性或HDP合并糖尿病女性的全因死亡风险未增加。
在分娩后5年内，患有两种或三种疾病（特别是HDP、糖尿病和/或孕前HTN）的女性发生CHD和全因死亡率最高，NHB女性的所有发生率均高于NHW女性。因此，实施临床预防策略以改善育龄女性的危险因素筛查和识别至关重要。
