Is hypertensive disorder linked to cardiovascular death risk in pregnant women?

Among the hypertensive disorders that cause dangerously high blood pressure during pregnancy — chronic hypertension, gestational hypertension, preeclampsia without severe features, preeclampsia with severe features, superimposed preeclampsia and eclampsia — all but gestational diabetes were associated with a doubling in the risk of fatal cardiovascular disease compared to women with normal blood pressure. Eclampsia, a condition whereby hypertensive disorders cause seizures, is associated with a nearly 58-fold increase in fatal cardiovascular disease.

“Maternal and postpartum mortality rates in the U.S. are higher than in other high-income countries and rising, but more than half of cardiovascular disease-related deaths are preventable. This study provides new information about how each hypertensive disorder is related to fatal cardiovascular disease, so healthcare providers can monitor patients with such complications more closely and develop strategies for keeping them healthy postpartum,” said lead author Rachel Lee, a data analyst at Rutgers Robert Wood Johnson Medical School.

In the study, researchers used the Nationwide Readmissions Database to examine pregnancy-related mortality rates for females 15 to 54 years old from 2010 to 2018. Data from more than 33 million delivery hospitalizations identified hypertensive disorders in 11 percent of patients, although the number increased with time. In 2010, 9.4 percent of patients in the study had hypertensive disorders of pregnancy. By 2018, that figure had risen by more than half to 14.4 percent.

“Cases of chronic hypertension are rising sharply among people of childbearing age, but optimal treatment strategies remain uncertain. While we’re treating more pregnant people with mild hypertension with antihypertensive medications, there remain many questions about the right definitions of hypertension in pregnant compared to non-pregnant individuals,” said Lee.

“Pregnant people with hypertensive disorders, especially those with pre-existing hypertension, need high-quality care as heart disease and related cardiac symptoms can be confused with common symptoms of normal pregnancy. Delays in diagnosis are associated with an increased incidence of preventable complications. Early identification and optimal treatment of hypertensive disorders, especially preeclampsia-eclampsia, are crucial for the primary prevention of maternal stroke,” concluded the study authors.

Reference: Rachel Lee, Justin S. Brandt, K. S. Joseph, Cande V. Ananth Pregnancy-associated mortality due to cardiovascular disease: Impact of hypertensive disorders of pregnancy; Journal: Paediatric and Perinatal Epidemiology; https://doi.org/10.1111/ppe.13055