Maternal Coronary Heart Disease, Stroke, and Mortality Within 1, 3, and 5 Years of Delivery Among Women With Hypertensive Disorders of Pregnancy and Pre‐Pregnancy Hypertension

Abstract

Background Pre‐pregnancy hypertension and hypertensive disorders of pregnancy (HDP; preeclampsia, eclampsia, gestational hypertension) are major health risks for maternal morbidity and mortality. However, it is unknown if racial/ethnic differences exist. We aimed to determine the impact of HDP and pre‐pregnancy hypertension on maternal coronary heart disease, stroke, and mortality risk ≤1, 3, and 5 years post‐delivery and by race/ethnicity ≤5 years. Methods and Results This retrospective cohort study included women aged 12 to 49 years with a live, singleton birth between 2004 to 2016 (n=254 491 non‐Hispanic White; n=137 784 non‐Hispanic Black; n=41 155 Hispanic). Birth and death certificates and International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification (ICD‐9‐CM and ICD‐10‐CM) diagnosis codes in hospitalization/emergency department visit data defined HDP, pre‐pregnancy hypertension, incident coronary heart disease and stroke, and all‐cause mortality. During at least 1 pregnancy of the 433 430 women, 2.3% had pre‐pregnancy hypertension with superimposed HDP, 15.7% had no pre‐pregnancy hypertension with HDP, and 0.4% had pre‐pregnancy hypertension without superimposed HDP, whereas 81.6% had neither condition. Maternal deaths from coronary heart disease, stroke, and all causes totaled 2136. Within 5 years of delivery, pre‐pregnancy hypertension, and HDP were associated with all‐cause mortality (hazard ratio [HR], 2.21; 95% CI, 1.61–3.03), incident coronary heart disease (HR, 3.79; 95% CI, 3.09–4.65), and incident stroke (HR, 3.10; 95% CI, 2.09–4.60). HDP alone was related to all outcomes. Race/ethnic differences were observed for non‐Hispanic Black and non‐Hispanic White women, respectively, in the associations of pre‐pregnancy hypertension and HDP with all‐cause mortality within 5 years of delivery (HR, 2.34 [95% CI, 1.58–3.47]; HR, 2.11 [95% CI, 1.23–3.65]; P interaction=0.001). Conclusions Maternal cardiovascular outcomes including mortality were increased ≤5 years post‐delivery in HDP, pre‐pregnancy hypertension, or pre‐pregnancy hypertension with superimposed HDP. The race/ethnic interaction for all‐cause mortality ≤5 years of delivery warrants further research.

Keywords

• cardiovascular disease
• disparities
• hypertensive disorders of pregnancy
• maternal outcomes
• mortality
• pre‐pregnancy hypertension