13 - Association between hypertensive disorders of pregnancy and new cardiovascular diseases within 24 months postpartum

Despite the association of hypertensive disorders of pregnancy (HDP) and cardiovascular disease (CVD), the optimal strategy for postpartum CVD screening is unclear, in part due to the lack of data on which specific cardiovascular diagnoses have the greatest risk profiles postpartum. Therefore, we aimed to delineate the risk of six cardiovascular diagnoses in the first 24 months’ postpartum among patients with HDP compared with patients without HDP.

Study Design:

Our longitudinal population-based study included pregnant individuals with deliveries during 2007-2019 in the Maine Health Data Organization’s All Payer Claims Data. We excluded those with pre-existing CVD, multifetal gestations, or no continuous insurance. HDP and CVD (categorized by specific condition: heart failure, ischemic heart disease, arrhythmia/cardiac arrest, cardiomyopathy, cerebrovascular disease/stroke, and chronic hypertension) were identified by ICD9/10 codes. Cox models were used to estimate hazard ratios, adjusting for potential confounding factors.

Results:

Of the 123,125 pregnancies examined (Table 1), the cumulative risk of new CVD within 24 months’ postpartum were 0.2% for heart failure, ischemic heart disease, and arrhythmia/cardiac arrest (respectively); 0.3% for cardiomyopathy; 0.7% for cerebrovascular disease/stroke; and 2.1% for hypertension. Those with HDP had increased risk of new hypertension, heart failure, cerebrovascular disease, and cardiomyopathy within the first 24 months postpartum (aHR 7.35 (95% CI 6.62-8.16), aHR 2.76 (95% CI 1.87-4.08), aHR 1.42 (95% CI 1.06-1.90), and 2.86 (95% CI 1.94-4.22), respectively) as compared to those without HDP (Table 2). There was no association with ischemic heart disease or cardiac arrest/arrhythmia.

Conclusion:

Patients with HDP had a significantly increased risk for development of chronic hypertension, heart failure, cerebrovascular disease, and cardiomyopathy within 24 months postpartum. Future studies in other populations are needed to inform how to tailor postpartum cardiovascular screening and intervention to specifically target these outcomes.