S A M Schokker1, M F Van Oostwaard2, E M Melman3, J P Van Kessel3, M I Baharoglu4, Y B W E M Roos4, L Vogt5, R J De Winter6, B W Mol7, W Ganzevoort3. 1. Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: s.a.schokker@amc.nl. 2. Department of Obstetrics and Gynecology, Beatrixziekenhuis, Gorinchem, The Netherlands. 3. Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands. 4. Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands. 5. Department of Nephrology, Academic Medical Center, Amsterdam, The Netherlands. 6. Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands. 7. The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Australia.
Abstract
BACKGROUND: Strong associations have been established in nationwide registry studies between hypertensive disorders of pregnancy (HDP) and later vascular morbidities and mortality. The aim of this case-control study is to examine the interdependent relationships of different predictive factors for vascular disease and HDP, because they are not clearly elucidated due to lack of detail in registries. METHODS AND RESULTS: We assembled three different case groups of women who had cerebrovascular, cardiovascular, or hypertensive kidney disease before the age of 55. The control group consisted of age-matched women who underwent hysterectomy for benign reasons. We assessed the occurrence of HDP in previous pregnancies. The strength of the association with vascular morbidities was tested with multivariable logistic regression in comparison with classic vascular risk factors. In all case groups, previous HDP occurred more frequent than in the control group. In logistic regression analysis, previous HDP were the strongest predictor in the cerebrovascular group (OR 4.2; 95% confidence interval [CI] 1.6-11.0). In the cardiovascular group and the kidney failure group a similar association was found, however, this was not statistically significant (OR 4.4 (95% CI 0.82-4) and 2.9 (95% CI 0.61-14), respectively). CONCLUSIONS: Previous hypertensive disorders of pregnancy are a strong predictor for later vascular morbidity. This is partially mediated through the presence of classic vascular risk factors, but our data suggest it is also an independent predictor.
BACKGROUND: Strong associations have been established in nationwide registry studies between hypertensive disorders of pregnancy (HDP) and later vascular morbidities and mortality. The aim of this case-control study is to examine the interdependent relationships of different predictive factors for vascular disease and HDP, because they are not clearly elucidated due to lack of detail in registries. METHODS AND RESULTS: We assembled three different case groups of women who had cerebrovascular, cardiovascular, or hypertensive kidney disease before the age of 55. The control group consisted of age-matched women who underwent hysterectomy for benign reasons. We assessed the occurrence of HDP in previous pregnancies. The strength of the association with vascular morbidities was tested with multivariable logistic regression in comparison with classic vascular risk factors. In all case groups, previous HDP occurred more frequent than in the control group. In logistic regression analysis, previous HDP were the strongest predictor in the cerebrovascular group (OR 4.2; 95% confidence interval [CI] 1.6-11.0). In the cardiovascular group and the kidney failure group a similar association was found, however, this was not statistically significant (OR 4.4 (95% CI 0.82-4) and 2.9 (95% CI 0.61-14), respectively). CONCLUSIONS: Previous hypertensive disorders of pregnancy are a strong predictor for later vascular morbidity. This is partially mediated through the presence of classic vascular risk factors, but our data suggest it is also an independent predictor.