Chronic Hypertension and Cardiovascular Disease After Preeclampsia: A Danish Nationwide Register-Based Cohort Study Identifying Women at High Risk
Helene Nielsen, Gabriela Byskov Petersen, Maria Guldbrandt Hauge, Rasmus Wibaek, Jesper James Linde, Marianne Johansen, Peter Damm, Stine Byberg, Karoline Kragelund NielsenAbstract
Aims
Preeclampsia is associated with future cardiovascular disease (CVD), yet systematic approaches to identify those requiring intensified prevention are lacking. We aimed to characterise these women and identify subgroups at particularly high risk of later chronic hypertension or CVD.
Methods
Using Danish nationwide registries, we followed primiparous women with preeclampsia who gave birth during 2004–2018 until December 2022. Using Poisson regression models we estimated incidence rate ratios (IRR) of later chronic hypertension or CVD.
Results
Of 17,434 women with preeclampsia, 2,372 developed chronic hypertension and 373 developed CVD. Early-onset preeclampsia was more common among those who later developed chronic hypertension (13.3% vs. 7.4%) or CVD (12.1% vs. 8.1%). Higher IRs of both outcomes (IRRs [95% CI] for chronic hypertension and CVD, respectively) were found for smoking in pregnancy (1.20 [1.05–1.36]; 1.24 [0.86–1.80]), gestational diabetes (1.36 [1.19–1.56]; 1.25 [0.80–1.94]), pre-existing type 1 diabetes (2.09 [1.57–2.78]; 1.89 [0.77–4.59]) and type 2 diabetes (1.47 [0.93–2.33]; 1.47 [0.36–6.01]), and low education (1.50 [1.31–1.72]; 2.77 [1.92–3.98]). The regions with the highest IRR differed between outcomes, and IRs were higher than among Danish-born women for some regions and lower for others. IRs also increased with higher BMI and age, more steeply above 25 kg/m2 and 40 years.
Conclusion
Early-onset preeclampsia, smoking, co-existing diabetes, certain ethnic origins, lower educational level, higher maternal age at delivery, and pre-pregnancy BMI ≥ 25 kg/m2 were identified as risk factors for later chronic hypertension or CVD among women with preeclampsia.