Association Between Hypertensive Disorders of Pregnancy and Later Risk of Cardiomyopathy EDITORIAL COMMENT

作者：Behrens Ida^*; Basit Saima; Lykke Jacob Alexander; Ranthe Mattis Flyvholm; Wohlfahrt Jan; Bundgaard Henning; Melbye Mads; Boyd Heather A

来源：Obstetrical and Gynecological Survey, 2016, 71(7): 387-389.

Hypertensive disorders of pregnancy (HDP), which include preeclampsia and gestational hypertension, are characterized by de novo hypertension, with or without abnormal biochemical findings, in the second half of pregnancy and occur in up to 10% of pregnancies worldwide. The aim of this study was to investigate the association between HDP and cardiomyopathy after the peripartum period. Using the National Patient Register and the Medical Birth Register, a nationwide register-based cohort study was conducted. Using Cox regression, rates of cardiomyopathy in women with and without a history of HDP were compared in all women in Denmark with at least 1 pregnancy ending in live birth or stillbirth during 1978 to 2012. The primary outcome of the study was cardiomyopathy more than 5 months after delivery up to 34 years, 7 months. Exposure included women with a hypertensive disorder of pregnancy (severe or moderate preeclampsia; gestational hypertension).
During the study period, the primary cohort included 2,067,633 eligible pregnancies. Of these, 76,108 had a hypertensive disorder of pregnancy. In all, 1577 women developed cardiomyopathy during follow-up at a mean age of 48.5 years. When compared with women with normotensive pregnancies, women with a history of HDP had significantly increased rates of cardiomyopathy (7.7/100,000 person-years in normotensive pregnancies, as compared with 15.6/100,000 person-years in women with severe preeclampsia, 14.6/100,000 person-years with moderate preeclampsia, and 17.3/100,000 person-years in women with gestational hypertension). The adjusted hazards ratios were 2.20 (95% confidence interval [CI], 1.50-3.23) for severe preeclampsia, 1.89 (95% CI, 1.55-2.23) for moderate preeclampsia, and 2.06 (95% CI, 1.50-2.82) for gestational hypertension. Results also indicated that these increases persisted for more than 5 years after the latest pregnancy.
This study concludes that women with a history of HDP, compared with women without such a history, had a small but statistically significant increased risk of cardiomyopathy more than 5 months after delivery. Further research is necessary to understand whether there is a causal mechanism behind this association.

• 出版日期2016-7