Hypertensive diseases of pregnancy and risk of hypertension and stroke in later life: results from cohort study
BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7394.845 (Published 19 April 2003) Cite this as: BMJ 2003;326:845
- Brenda J Wilson, senior lecturera,
- M Stuart Watson, lecturera,
- Gordon J Prescott, research fellow in medical statisticsa,
- Sarah Sunderland, research nursea,
- Doris M Campbell, readerb,
- Philip Hannaford, professorc,
- W Cairns S Smith, professor (w.c.s.smith{at}abdn.ac.uk)a
- a Department of Public Health, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD
- b Department of Obstetrics and Gynaecology, University of Aberdeen
- c Department of General Practice and Primary Care, University of Aberdeen
- Correspondence to: W C S Smith
- Accepted 6 March 2003
Abstract
Objective: To examine the association between hypertensive diseases of pregnancy (gestational hypertension and pre-eclampsia) and the development of circulatory diseases in later life.
Design: Cohort study of women who had pre-eclampsia during their first singleton pregnancy. Two comparison groups were matched for age and year of delivery, one with gestational hypertension and one with no history of raised blood pressure.
Setting: Maternity services in the Grampian region of Scotland.
Participants: Women selected from the Aberdeen maternity and neonatal databank who were resident in Aberdeen and who delivered a first, live singleton from 1951 to 1970.
Main outcome measures: Current vital and cardiovascular health status ascertained through postal questionnaire survey, clinical examination, linkage to hospital discharge, and mortality data.
Results: There were significant positive associations between pre-eclampsia/eclampsia or gestational hypertension and later hypertension in all measures. The adjusted relative risks varied from 1.13-3.72 for gestational hypertension and 1.40-3.98 for pre-eclampsia or eclampsia. The adjusted incident rate ratio for death from stroke for the pre-eclampsia/eclampsia group was 3.59 (95% confidence interval 1.04 to 12.4).
Conclusions: Hypertensive diseases of pregnancy seem to be associated in later life with diseases related to hypertension. If greater awareness of this association leads to earlier diagnosis and improved management, there may be scope for reducing a proportion of the morbidity and mortality from such diseases.
What is already known on this topic
What is already known on this topic Much is known about the effect of cardiovascular risks factors that are shared by men and women, but less on those specific to women
Retrospective studies, based on patient recall, suggest that hypertension in pregnancy may be associated with increased risk of cardiovascular diseases in later life
What this study adds
What this study adds Prospective recording of blood pressure and proteinuria shows that women who experienced raised blood pressure in pregnancy have a long term risk of hypertension
Women who experience raise blood pressure in pregnancy have an increased risk of stroke and, to a lesser extent, an increased risk of ischaemic heart disease
Long term cardiovascular risks are greater for women who had pre-eclampsia than those who experienced gestational hypertension (hypertension without proteinuria)
Footnotes
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Funding British Heart Foundation, grant number PG/95130. The guarantor accepts full responsibility for the conduct of the study, had access to the data, and controlled the decision to publish.
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Competing interests None declared.
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Ethical approval The study protocol was approved by the Joint Grampian Health Board and University of Aberdeen ethics committee, the information and statistics division privacy advisory committee and the Grampian Health Board general practice subcommittee.
- Accepted 6 March 2003