(VP040) EARLY CARDIOMETABOLIC MULTIMORBIDITY IN ALBERTA FEMALES AFTER HYPERTENSIVE DISORDERS OF PREGNANCY

Background: In Canada, multimorbidity (i.e., 2 chronic conditions within one individual) has increased in females of reproductive ages from 4.7 to 8.1 per 1000 deliveries between 2005 and 2014. This rise is alarming due to: 1) the direct impacts on health outcomes and quality of life; and 2) high healthcare utilization and costs. From a health systems’ perspective, knowledge of which populations are at highest risk of preventable chronic diseases is needed to direct limited preventive healthcare resources. Individuals who experience a hypertensive disorder of pregnancy (HDP) (~7-10% of all pregnancies in Canada) have a high risk of developing cardiometabolic disorders (i.e., hypertension, dyslipidemia, dysglycemia, kidney dysfunction and obesity) within the first 5 years after delivery, leading to premature cardiometabolic morbidity and mortality often ten years after delivery. At present, it is unknown whether cardiometabolic disorders cluster within individuals after HDP. This knowledge may help inform cardiometabolic prevention programs targeting females after pregnancy. The objective of this study was to determine the association of HDP with cardiometabolic multimorbidity in young females after pregnancy.

METHODS AND RESULTS: A population-based retrospective cohort was studied by linking several provincial administrative data sets (discharge abstract database, physician claims, emergency department visits, pharmaceutical information network and provincial laboratory results). Females who had deliveries from 2010-2020 were included excluding those with pre-pregnancy cardiometabolic chronic diseases (N=310,446). Participants were classified as having no HDP (control) (n=289472) and HDP (exposure) (20,974). The HDP group was classified by severity of HDP: gestational hypertension, pre-eclampsia and severe pre-eclampsia (i.e., HELLP syndrome, eclampsia) using ICD codes. Over a period of up to 10 years after delivery, 3.3% of women without HDP, 8.5% with HDP (8.4% with GHTN, 8.9% with preeclampsia, 7.4% with severe preeclampsia) developed multimorbidity (2 cardiometabolic diseases). The accumulation of multimorbidity was rapid, with 15% of individuals with HDP developing 2 comorbidities within 5-6 years of delivery.

Conclusion: Rising multimorbidity in Canada is becoming an emerging public health problem. Young females who have experienced any HDP are among those at highest risk (15% prevalence) of cardiometabolic multimorbidity within 5-6 years after delivery. Cardiometabolic health promotion programs (focused on primary prevention through health behaviour supports, cardiometabolic risk factor screening and management) targeting females with HDP after pregnancy may be a cost-effective strategy to reduce the burden of cardiometabolic chronic diseases in Canadians.