| Autor: |
Haas DM; Indiana University School of Medicine Indianapolis IN., Parker CB; RTI International Research Triangle Park NC., Marsh DJ; RTI International Research Triangle Park NC., Grobman WA; Northwestern University Feinberg School of Medicine Chicago IL., Ehrenthal DB; University of Wisconsin School of Medicine and Public Health Madison WI., Greenland P; Northwestern University Feinberg School of Medicine Chicago IL., Bairey Merz CN; Smidt Cedars-Sinai Heart Institute Los Angeles CA., Pemberton VL; National Heart, Lung, and Blood Institute Bethesda MD., Silver RM; University of Utah School of Medicine Salt Lake City UT., Barnes S; Indiana University School of Medicine Indianapolis IN., McNeil RB; RTI International Research Triangle Park NC., Cleary K; Columbia University School of Medicine New York NY., Reddy UM; Eunice Kennedy Shriver National Institute of Child Health and Human Development Bethesda MD., Chung JH; University of California-Irvine Irvine CA., Parry S; University of Pennsylvania School of Medicine Philadelphia PA., Theilen LH; University of Utah School of Medicine Salt Lake City UT., Blumenthal EA; University of California-Irvine Irvine CA., Levine LD; University of Pennsylvania School of Medicine Philadelphia PA., Mercer BM; Case Western Reserve University-The MetroHealth System Cleveland OH., Simhan H; University of Pittsburgh School of Medicine Pittsburgh PA., Polito L; Case Western Reserve University-The MetroHealth System Cleveland OH., Wapner RJ; Columbia University School of Medicine New York NY., Catov J; University of Pittsburgh School of Medicine Pittsburgh PA., Chen I; Los Angeles Biomedical Research Institute Los Angeles CA., Saade GR; University of Texas Medical Branch Galveston TX. |
| Abstrakt: |
Background Identifying pregnancy-associated risk factors before the development of major cardiovascular disease events could provide opportunities for prevention. The objective of this study was to determine the association between outcomes in first pregnancies and subsequent cardiovascular health. Methods and Results The Nulliparous Pregnancy Outcomes Study Monitoring Mothers-to-be Heart Health Study is a prospective observational cohort that followed 4484 women 2 to 7 years (mean 3.2 years) after their first pregnancy. Adverse pregnancy outcomes (defined as hypertensive disorders of pregnancy, small-for-gestational-age birth, preterm birth, and stillbirth) were identified prospectively in 1017 of the women (22.7%) during this pregnancy. The primary outcome was incident hypertension (HTN). Women without adverse pregnancy outcomes served as controls. Risk ratios (RR) and 95% CIs were adjusted for age, smoking, body mass index, insurance type, and race/ethnicity at enrollment during pregnancy. The overall incidence of HTN was 5.4% (95% CI 4.7% to 6.1%). Women with adverse pregnancy outcomes had higher adjusted risk of HTN at follow-up compared with controls (RR 2.4, 95% CI 1.8-3.1). The association held for individual adverse pregnancy outcomes: any hypertensive disorders of pregnancy (RR 2.7, 95% CI 2.0-3.6), preeclampsia (RR 2.8, 95% CI 2.0-4.0), and preterm birth (RR 2.7, 95% CI 1.9-3.8). Women who had an indicated preterm birth and hypertensive disorders of pregnancy had the highest risk of HTN (RR 4.3, 95% CI 2.7-6.7). Conclusions Several pregnancy complications in the first pregnancy are associated with development of HTN 2 to 7 years later. Preventive care for women should include a detailed pregnancy history to aid in counseling about HTN risk. Clinical Trial Registration URL: http://www.clinicaltrials.gov Unique identifier: NCT02231398. |
Plný text