Could Hypertension During Pregnancy Raise Mortality Risk?

In a new study, researchers have found that women with a history of hypertensive disease (HDP) during pregnancy are at greater risk of early mortality.

In an effort to evaluate whether women with a record of any hypertensive disease during pregnancy face increased risk for early mortality, as well as to determine the timing and most common cause of their deaths, a team of researchers used the Utah Population Database to look at births from 1939 to 2012.
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Relying on birth certificate data, the investigators assigned an HDP diagnosis and, when possible, the category of disease—gestational hypertension, preeclampsia, HELLP syndrome, and eclampsia. Exposed women had a singleton pregnancy complicated by HDP, and lived in Utah for more than 1 year following delivery, according to the authors, who note that primary cause of death was ascertained from death certificates.

Among the 2,083,331 birth certificates the researchers analyzed, 61,727, or 3%, had a history of hypertensive disease. Among all participants, all-cause mortality was “significantly increased” among those with a history of HDP, who were also found to be at the highest risk of mortality due to Alzheimer’s disease, diabetes, ischemic heart disease, and stroke. Overall, the authors determined that women with a history of HDP showed an increased risk of early mortality, with the highest hazard ratios for neurologic, endocrine, and circulatory causes, and increased mortality risk for these women beginning roughly 20 years after pregnancy.

Study author Lauren Theilen, MD, a visiting professor in the departments of obstetrics and gynecology at the University of Utah Health Sciences Center, urges primary care providers to “be aware of the long-term implications of a history of hypertensive disease of pregnancy.”

Recognizing these potential repercussion is critical, “so that these women can receive timely screening and, when possible, interventions to improve long-term health outcomes,” says Theilen, who is presenting the study’s findings at the Society for Maternal-Fetal Medicine's annual meeting, held Feb 1 - 6 in Atlanta, Ga.

—Mark McGraw

Wikström A, Gunnarsdottir J, Nelander M, et al. Prehypertension in pregnancy and risks of small for gestational age infant and stillbirth. Hypertension. February 1, 2016 [epub ahead of print]. doi: 10.1161/HYPERTENSIONAHA.115.06752.