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Maternal Coronary Heart Disease, Stroke, and Mortality Within 1, 3, and 5 Years of Delivery Among Women With Hypertensive Disorders of Pregnancy and Pre‐Pregnancy Hypertension
- Source :
- Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
- Publication Year :
- 2021
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2021.
-
Abstract
- Background Pre‐pregnancy hypertension and hypertensive disorders of pregnancy (HDP; preeclampsia, eclampsia, gestational hypertension) are major health risks for maternal morbidity and mortality. However, it is unknown if racial/ethnic differences exist. We aimed to determine the impact of HDP and pre‐pregnancy hypertension on maternal coronary heart disease, stroke, and mortality risk ≤1, 3, and 5 years post‐delivery and by race/ethnicity ≤5 years. Methods and Results This retrospective cohort study included women aged 12 to 49 years with a live, singleton birth between 2004 to 2016 (n=254 491 non‐Hispanic White; n=137 784 non‐Hispanic Black; n=41 155 Hispanic). Birth and death certificates and International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification ( ICD‐9‐CM and ICD‐10‐CM ) diagnosis codes in hospitalization/emergency department visit data defined HDP, pre‐pregnancy hypertension, incident coronary heart disease and stroke, and all‐cause mortality. During at least 1 pregnancy of the 433 430 women, 2.3% had pre‐pregnancy hypertension with superimposed HDP, 15.7% had no pre‐pregnancy hypertension with HDP, and 0.4% had pre‐pregnancy hypertension without superimposed HDP, whereas 81.6% had neither condition. Maternal deaths from coronary heart disease, stroke, and all causes totaled 2136. Within 5 years of delivery, pre‐pregnancy hypertension, and HDP were associated with all‐cause mortality (hazard ratio [HR], 2.21; 95% CI, 1.61–3.03), incident coronary heart disease (HR, 3.79; 95% CI, 3.09–4.65), and incident stroke (HR, 3.10; 95% CI, 2.09–4.60). HDP alone was related to all outcomes. Race/ethnic differences were observed for non‐Hispanic Black and non‐Hispanic White women, respectively, in the associations of pre‐pregnancy hypertension and HDP with all‐cause mortality within 5 years of delivery (HR, 2.34 [95% CI, 1.58–3.47]; HR, 2.11 [95% CI, 1.23–3.65]; P interaction=0.001). Conclusions Maternal cardiovascular outcomes including mortality were increased ≤5 years post‐delivery in HDP, pre‐pregnancy hypertension, or pre‐pregnancy hypertension with superimposed HDP. The race/ethnic interaction for all‐cause mortality ≤5 years of delivery warrants further research.
- Subjects :
- Male
Gestational hypertension
Time Factors
Epidemiology
Blood Pressure
Coronary Artery Disease
030204 cardiovascular system & hematology
0302 clinical medicine
cardiovascular disease
Pregnancy
Cause of Death
Child
Stroke
Original Research
disparities
030219 obstetrics & reproductive medicine
maternal outcomes
Obstetrics
Pregnancy Outcome
Middle Aged
stroke
Survival Rate
Maternal Mortality
Hypertension
Female
Cardiology and Cardiovascular Medicine
Adult
Race and Ethnicity
medicine.medical_specialty
Adolescent
Maternal morbidity
Preeclampsia
Young Adult
03 medical and health sciences
medicine
Humans
Women
Retrospective Studies
Go Red for Women Spotlight
Eclampsia
business.industry
Pre pregnancy
hypertensive disorders of pregnancy
Infant, Newborn
race/ethnicity
Hypertension, Pregnancy-Induced
medicine.disease
mortality
pre‐pregnancy hypertension
United States
Coronary heart disease
business
Follow-Up Studies
Subjects
Details
- ISSN :
- 20479980
- Volume :
- 10
- Database :
- OpenAIRE
- Journal :
- Journal of the American Heart Association
- Accession number :
- edsair.doi.dedup.....6e793337b727a30fc430210cb64617fb