The online version of this article (https://doi.org/10.1186/s12933-018-0764-2) contains supplementary material, which is available to authorized users.
Women with history of hypertensive disorders of pregnancy (HDP) are at increased risk of early onset cardiovascular disease and type 2 diabetes (T2D). We aimed to investigate the extent to which HDP is also associated with midlife development of T2D and hypertension above and beyond established risk factors.
We included parous women who attended population-based structured clinical visits at age 50 and 60 years in Sweden 1991–2013 (N = 6587). Women with prior diabetes mellitus, stroke, or ischemic heart disease at age 50 years were excluded. Data on reproductive history were collected from registries. To study the association between history of HDP and the between-visits development of T2D, hypertension, and clinical risk factors of cardiometabolic disease (body mass index (BMI), blood pressure, and total cholesterol), we utilized multivariable adjusted regression models (logistic, log binomial, and linear regression, respectively). Models included data on outcome risk factors at age 50 years, e.g. BMI, 75 g 2 h oral glucose tolerance test result, and mean arterial pressure, respectively.
Between ages 50 and 60 years, 5.8% of initially disease-free women developed T2D and 31.6% developed hypertension. History of HDP was associated with increased risk of developing T2D between age 50 and 60 years even when adjusting for risk factors, including BMI, at age 50 years (odds ratio (OR) 1.96, 95% confidence interval (CI) 1.29–2.98). By contrast, the higher risk of developing hypertension observed in women with history of HDP (relative risk (RR) 1.47, 95% CI 1.22–1.78) was attenuated when adjusted for risk factors (RR 1.09, 95% CI 0.94–1.25). Participants with a history of HDP had higher mean BMI and blood pressure at age 50 years, with levels roughly corresponding to those observed at age 60 years in unaffected women.
Women with history of HDP are not only at higher risk of cardiometabolic disease during their reproductive years, but HDP is also associated with midlife T2D development above and beyond established risk factors.
Additional file 1: Additional methods and results. Table S1: Descriptive comparison of cardiometabolic status at age 50 years between women alive at age 60 years with or without clinical visit. Table S2: Descriptive comparison of cardiometabolic status between women with and without full reproductive history at age 50 years.
Catov JM, Bairey-Merz N, Rich-Edwards J. Cardiovascular health during pregnancy: future health implications for mothers. Curr Epidemiol Rep. 2017;4:232–8. CrossRef
Hallmans G, Agren A, Johansson G, Johansson A, Stegmayr B, Jansson J-H, et al. Cardiovascular disease and diabetes in the Northern Sweden Health and Disease Study Cohort-evaluation of risk factors and their interactions. Scand J Public Health. 2003;61:18–24. CrossRef
Fraser A, Nelson SM, Macdonald-Wallis C, Cherry L, Butler E, Sattar N, et al. Associations of pregnancy complications with calculated cardiovascular disease risk and cardiovascular risk factors in middle age: the Avon Longitudinal Study of Parents and Children. Circulation. 2012;125:1367–80. CrossRefPubMedPubMedCentral
Drost J, van der Schouw Y, Maas A, Verschuren W. Longitudinal analysis of cardiovascular risk parameters in women with a history of hypertensive pregnancy disorders: the Doetinchem Cohort Study. BJOG Int J Obstet Gynaecol. 2013;120:1333–9. CrossRef
Kajantie E, Osmond C, Eriksson JG. Gestational hypertension is associated with increased risk of type 2 diabetes in adult offspring: the Helsinki Birth Cohort Study. Am J Obstet Gynecol. 2017;216:281e1. CrossRef
American Diabetes Association. 12. Management of Diabetes in Pregnancy. Diabetes Care. 2015;38(Supplement 1):S77–9. CrossRef
American College of Obstetricians and Gynecologists. Task Force on hypertension in pregnancy. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on hypertension in pregnancy. Obstet Gynecol. 2013;122:1122–31. CrossRef
- Midlife development of type 2 diabetes and hypertension in women by history of hypertensive disorders of pregnancy
Paul W. Franks
Janet W. Rich-Edwards
- BioMed Central
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