Study Finds Recurrent Hypertensive Disease of Pregnancy Associated with Early Mortality Essay
LAS VEGAS (Jan. 23, 2017)—In a study to be presented Friday, Jan. 27, in the oral plenary session at 8 a.m. PST, at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting™, researchers with University of Utah Health Sciences Center, Intermountain Healthcare and the Huntsman Cancer Institute (all in Salt Lake City, Utah), will present the study, Long-term mortality risk and life expectancy following recurrent hypertensive disease of pregnancy.
Researchers have long determined that pregnancy can provide insight into future health. Because of the stress it puts on the body, pregnancy may unmask an underlying predisposition to health problems.
The study looked at births from 1939 to 2012 using the Utah Population Database. Using birth certificate data, researchers determined the number of pregnancies affected by hypertensive disease of pregnancy for each woman. Hypertensive disease of pregnancy is a group of diseases which includes preeclampsia, eclampsia, gestational hypertension and chronic hypertension. Primary cause of death was determined from death certificates and mortality risk by primary cause of death was compared between women with HDP and women without a history of HDP.
In the study, the researchers found that women who have two or more pregnancies complicated by hypertensive disease of pregnancy have a higher risk for early mortality from several causes compared to women who only have one affected pregnancy.
Existing recommendations for postpartum and prenatal care that may prevent recurrent hypertensive disease of pregnancy include the use of reliable contraception following delivery to prevent unintended pregnancy and taking low-dose aspirin in subsequent pregnancies to reduce recurrence risk.
Lauren Theilen, M.D. one of the primary researchers of the study and the presenter of the research at the upcoming SMFM annual meeting, explained, “Importantly, we are unable to say whether the hypertensive disease of pregnancy plays a causal role here, but we feel that further study is warranted to determine whether interventions such as early screening for chronic disease may improve long-term health outcomes among these women.”
Abstract #45 Long-term mortality risk and life expectancy following recurrent hypertensive disease of pregnancy
Lauren Theilen1,2 , Huong Meeks3 , Alison Fraser3 , M. Sean Esplin1,2 , Ken R. Smith3 , Michael Varner1,2 1 University of Utah Health Sciences Center, Salt Lake City, UT, 2 Intermountain Healthcare, Salt Lake City, UT, 3 Huntsman Cancer Institute, Salt Lake City, UT
OBJECTIVE: To determine whether women with recurrent hypertensive disease of pregnancy (HDP) have increased risk for early mortality and shorter life spans, and to determine the timing and most common causes of their deaths.
STUDY DESIGN: We defined a cohort of births from 1939-2012 using the Utah Population Database. Using birth certificate data, we determined the number of pregnancies affected by HDP for each woman (0, 1, or >1). Exposed women had 1 singleton pregnancy complicated by HDP and lived in Utah for 1 year following delivery. Exposed women (with HDP) were matched 1:2 to unexposed women by age, year of childbirth, and parity at time of index pregnancy. Primary cause of death (COD) was determined from death certificates. Mortality risk by primary COD was compared between exposed women (stratified by number of affected pregnancies) and unexposed women using Cox regression to adjust for infant sex, gestational age at delivery, parental education, ethnicity, and marital status.
RESULTS: We identified 57,384 women with at least one pregnancy complicated by HDP (49,598 women with 1 affected pregnancy and 7,786 women with >1 affected pregnancies). These exposed women were matched to 114,768 unexposed women. As of 2016, 11,894 women were deceased: 4,722 (8.2%) exposed and 7,172 (6.3%) unexposed. Recurrent HDP was significantly associated with an increased risk of all-cause mortality (aHR 2.04, 95% CI 1.76-2.36) as well as mortality due to diabetes (aHR 4.33, 95% CI 2.21-8.47), ischemic heart disease (aHR 3.30, 95% CI 2.02-5.40), and stroke (aHR 5.10, 95% CI 2.62-9.92) (Table). In a companion analysis using life table methods, for women whose index pregnancy delivered between 1939-1959 (n¼10,488), those with >1 pregnancy complicated by HDP had shorter life expectancies assessed from the time of the index childbirth than mothers who had only 1 pregnancy or 0 pregnancies complicated by HDP (48.92 vs 51.91 vs 55.48 years, respectively). The figure illustrates the survival curve in years since the index pregnancy for women with 0, 1, or >1 pregnancies affected by HDP.
CONCLUSION: Women with a history of HDP have increased mortality risk and decreased life expectancy compared to women without a history of HDP. This risk increases further with >1 pregnancy affected by HDP.