(917) Are hypertensive disorders of pregnancy associated with vasomotor symptoms?

Hypertensive disorders of pregnancy (HDP) and perimenopausal vasomotor symptoms are both associated with endothelial dysfunction, but the relationship between HDP and vasomotor symptoms is unclear. We aimed to evaluate this association.

Study Design:

For this secondary analysis of the Women’s Health Initiative prospective observational cohort, we included participants who had at least one pregnancy lasting at least 6 months who provided history of HDP and vasomotor symptoms. We excluded participants with a history of bilateral oophorectomy or dementia or who could not recall whether they had HDP. Our primary exposure is history of HDP. Our primary outcome is history of vasomotor symptoms. Secondary outcomes  are duration and age of onset of vasomotor symptoms. Bivariate analyses compared baseline demographics between exposure groups. Unadjusted difference in vasomotor symptoms (chi-square), duration (Wilcoxon), and age at onset (t-test) are reported. Adjusted odds ratios for the association between exposure and primary outcome are reported from logistic regression. We tested for effect modification by hormone replacement therapy (HRT). In sensitivity analysis, the outcome was a composite of history of vasomotor symptoms or HRT.

Results: Of 161,808 WHI participants, 18,943 met inclusion criteria. Of these, 1,232 (6.5%) had a history of HDP. Demographics at enrollment are presented in the Table. The prevalence of vasomotor symptoms was higher among participants with a history of HDP (81% vs 77%, p=0.01). Participants with a history of HDP had longer duration [median (IQR) 5 (2, 10) vs 4 (2, 8) p< 0.001] and earlier age of onset [mean (SD) 47.6 (5.4) vs 48.5 (4.8) p< 0.001] of vasomotor symptoms. HDP was associated with vasomotor symptoms, and the observed association was not significantly different by HRT use (Figure). HDP was more strongly associated with a composite outcome of vasomotor symptoms or HRT (Figure).

Conclusion: A history of HDP is associated with perimenopausal vasomotor symptoms. This may reflect a shared endothelial dysfunction pathophysiology.