Extreme morning sickness during pregnancy tied to increased risk of CVD decades later: JAHA
Canada: A recent study published in the Journal of the American Heart Association found an association between hyperemesis gravidarum and subsequent development of cardiovascular disease years following pregnancy. The association is not dependent on whether preeclampsia is present or not.
The study also revealed that women with preeclampsia and hyperemesis gravidarum are at more than three times the risk of later cardiovascular hospitalization.
About 3% of pregnancies are affected by Hyperemesis gravidarum, with many women experiencing vomiting, nausea, weight loss, dehydration, and metabolic disturbances that can be severe enough to affect cardiovascular function. Previous studies have shown an association between Hyperemesis gravidarum and preeclampsia, but there is no clarity on whether hyperemesis gravidarum is a risk factor for CVD (cardiovascular disease). To clarify the same, Nathalie Auger, University of Montreal Hospital Research Centre, Montreal, QC, Canada, and colleagues aimed to determine the long‐term risk of CVD in women who experienced hyperemesis gravidarum with or without preeclampsia.
For this purpose, the researchers analyzed a longitudinal cohort of 1 413 166 pregnant women in Quebec between 1989 and 2021. They computed hazard ratios (HRs) for the association of hyperemesis gravidarum, preeclampsia, or both conditions with the risk of cardiovascular hospitalization. The follow-up of the women was done from their first pregnancy and up to 30 years later.
The study revealed the following findings:
- Among 1 413 166 women, 1.2% had hyperemesis gravidarum only, 4.9% preeclampsia only, and 0.08% had both conditions.
- After 32 years of follow‐up, cardiovascular disease incidence was 17.7 per 100 women with hyperemesis gravidarum only, 28.2 per 100 women with preeclampsia only, 30.9 per 100 women with both exposures and 14.0 per 100 women with neither exposure.
- Compared with no exposure, women with both hyperemesis and preeclampsia had the most significant risk of cardiovascular hospitalization (HR, 3.54), followed by women with preeclampsia only (HR, 2.58) and hyperemesis only (HR, 1.46).
- Having both hyperemesis gravidarum and preeclampsia was strongly associated with valve disease (HR, 3.38), heart failure (HR, 3.43), and cardiomyopathy (HR, 4.17).
The findings showed that women with hyperemesis gravidarum are at greater risk of cardiovascular disease decades after pregnancy than women without hyperemesis. Women with hyperemesis gravidarum and preeclampsia had the highest risk of CVD.
Cardiovascular outcomes with the highest risk include heart failure, valve disease, conduction disorder, pulmonary embolism, and cardiomyopathy. Women with hyperemesis gravidarum, particularly hyperemesis combined with preeclampsia, may benefit from closer monitoring in the years following pregnancy to prevent adverse cardiovascular events.
"Guidelines should consider hyperemesis gravidarum addition as a pregnancy‐related CV risk factor," the researchers wrote. "Women with a hyperemesis gravidarum history may benefit from counselling to address the increased risk of CVD and encourage heart‐healthy behaviours postpartum."
Reference:
Cécile B, Potter BJ, Lewin A, Healy-Profitós J, Brousseau É, Auger N. Risk of Cardiovascular Disease in Women With a History of Hyperemesis Gravidarum, With and Without Preeclampsia. J Am Heart Assoc. 2023 Jun 1:e029298. doi: 10.1161/JAHA.122.029298. Epub ahead of print. PMID: 37259983.
