Preeclampsia Linked to Negative CV Outcomes Following Pregnancy

Mary Downes Gastrich, PhD

A new look into the impact of preeclampsia on subsequent risk for cardiovascular events later in life is shedding light on just how much woman’s health can be impacted by this pregnancy complication.

Results from the 15-year study revealed women diagnosed with preeclampsia were at a significantly higher risk for a multitude of cardiovascular disease (CVD) events, including a nearly five-fold greater risk of cardiovascular death.

In an effort to assess how high blood pressure during their first pregnancy could affect risk for cardiovascular outcomes, investigators from Rutgers University conducted a retrospective analysis of data from the New Jersey Electronic Birth Certificate (EBC) database and the Myocardial Infarction Data Acquisition System (MIDAS). Using information obtained from each database, investigators sought to examine preeclampsia’s impact on short- and long-term cardiovascular outcomes.

For inclusion in the study, participants were required to be at least 18 years of age, residents of NJ, and have data recorded in EBC and MIDAS databases. Participants were excluded having previously given birth or having a history of myocardial infarction or stroke.

Using this criterion, investigators identified 6360 cases of women with preeclampsia between the ages of 18-53 years old. This cohort was then matched in a 3:1 ratio with 325,347 controls without preeclampsia identified through the EBC database.

The mean age of the preeclampsia group was 26.78 years, 55.61% were white, and 71.8% were non-Hispanic compared to 27.08 years, 62.26%, and 76.62%, respectively, in the controls group. Outcomes of interest for the analysis were myocardial infarction, stroke, cardiovascular death, and all-cause mortality. The median follow-up time for the study was 8.49 years. Investigators noted use of Kaplan-Meier estimates to assess each outcome included in the analysis.

Results revealed women with preeclampsia were more likely to suffer from all of the outcomes of interest included in the study. Upon adjustment for demographics and comorbidities, results still indicated a significantly increased risk for myocardial infarction (P = .0196), cardiovascular death (P = .007), and all-cause death (P = .0026) among women with preeclampsia.

When quantifying that risk, investigators calculated women with preeclampsia had a 3.94-times greater risk for myocardial infarction, a 4.66-times (95% CI, 1.52—14.26) greater risk for cardiovascular death (95% CI, 1.25–12.4), and a 2.32-times (95% CI, 1.34–4.02) greater risk of all-cause death than matched controls.

Investigators noted multiple limitations within their study. These limitations included a lack of patient level data, a lack of information pertaining to trimester when preeclampsia was diagnosed, databases did not contain information on the cardiometabolic profile of patients, and being limited to births that occurred in New Jersey. Investigators suggest the results of the study indicate the need for further exploration into outcomes and possible avenues to mitigate the apparent increase in risk.

“Women who were diagnosed with preeclampsia tended also to have a history of chronic high blood pressure, gestational diabetes and kidney disease and other medical conditions,” said lead investigator Mary Downes Gastrich, PhD, an associate professor at Rutgers Robert Wood Johnson Medical School, in a statement.

This study, “Preeclamptic Women Are at Significantly Higher Risk of Future Cardiovascular Outcomes Over a 15-Year Period,” is published in the Journal of Women’s Health.