Cardiovascular Biomarkers and Blood Pressure at 6 Weeks and 6-12 Months Postpartum in Women With or Without Hypertensive Disorders During Pregnancy: A Prospective Study
Abstract
Objective: To measure and compare cardiovascular biomarkers and blood pressure in women with hypertensive disorders of pregnancy (HDP) to those with normotensive pregnancies evaluated at 6 weeks and 6-12 months after delivery.
Material and Methods: A prospective cohort study of postpartum women following HDP and normotensive pregnancies at 6 weeks and 6-12 months postpartum was conducted. Postpartum blood pressure and cardiovascular biomarkers including body mass index (BMI), levels of serum high-sensitivity C-reactive protein (hs-CRP), creatinine, glucose, glycated hemoglobin, low-density lipoprotein cholesterol, and levels of urine microalbumin/creatinine ratio (UACR), sodium, and potassium were quantified.
Results: A total of 118 women involving 40 with previous preeclampsia (PE), 27 with gestational hypertension (GHT), 10 with chronic hypertension (CHT) during recent pregnancy, and 41 normotensive pregnancies were enrolled at 6 weeks postpartum, of whom 73 (61.9%) completed the study at 6-12 months postpartum. Women in the PE and GHT groups had significantly elevated blood pressure, serum hs-CRP and hypertension at 6 weeks and 6-12 months postpartum. Both the PE and CHT groups had an increase in UACR at 6-12 months postpartum. Multivariate linear regression showed that a history of PE and GHT was independently and persistently associated with increased postpartum blood pressure.
Conclusion: Women with HDP had increased blood pressure, risk of hypertension, and increased levels of biomarkers associated with cardiovascular risk at both 6 weeks and 6-12 months postpartum, including serum hs-CRP and UACR. Women with HDP should be counselled about cardiovascular risks as early as 6 weeks postpartum.
Keywords
Full Text:
PDFReferences
Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health 2014;2:e323-33.
Callaway LK, Mamun A, McIntyre HD, Williams GM, Najman JM, Nitert MD, et al. Does a history of hypertensive disorders of pregnancy help predict future essential hypertension? Findings from a prospective pregnancy cohort study. J Hum Hypertens 2013;27:309-14.
Irgens HU, Reisaeter L, Irgens LM, Lie RT. Long term mortality of mothers and fathers after pre-eclampsia: population based cohort study. BMJ 2001;323:1213-7.
Smith GC, Pell JP, Walsh D. Pregnancy complications and maternal risk of ischaemic heart disease: a retrospective cohort study of 129,290 births. Lancet 2001;357:2002-6.
Lykke JA, Langhoff-Roos J, Sibai BM, Funai EF, Triche EW, Paidas MJ. Hypertensive pregnancy disorders and subsequent cardiovascular morbidity and type 2 diabetes mellitus in the mother. Hypertension 2009;53:944-51.
Staff AC, Redman CW, Williams D, Leeson P, Moe K, Thilaganathan B, et al. Pregnancy and long-term maternal cardiovascular health: progress through harmonization of research cohorts and biobanks. Hypertension 2016;67:251-60.
Dall’Asta A, D’Antonio F, Saccone G, Buca D, Mastantuoni E, Liberati M, et al. Cardiovascular events following pregnancy complicated by pre-eclampsia with emphasis on comparison between early- and late-onset forms: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2021;57:698-709.
Behrens I, Basit S, Melbye M, Lykke JA, Wohlfahrt J, Bundgaard H, et al. Risk of post-pregnancy hypertension in women with a history of hypertensive disorders of pregnancy: nationwide cohort study. BMJ 2017;358:j3078.
Riise HKR, Sulo G, Tell GS, Igland J, Egeland G, Nygard O, et al. Hypertensive pregnancy disorders increase the risk of maternal cardiovascular disease after adjustment for cardiovascular risk factors. Int J Cardiol 2019;282:81-7.
Boucheron P, Lailler G, Moutengou E, Regnault N, Gabet A, Deneux-Tharaux C, et al. Hypertensive disorders of pregnancy and onset of chronic hypertension in France: the nationwide CONCEPTION study. Eur Heart J 2022;43:3352-61.
ACOG. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol 2020;135:e237-60.
Firoz T, Sotunsa J, Adetoro OO. Treatment postpartum – immediate and long term. In: Magee LA, von Dadelszen P, Stones W, Mathai M, editors. The FIGO textbook of pregnancy hypertension: an evidence-based guide to monitoring, prevention and management. London: The Global Library of Women’s Medicine; 2016;p.215-32.
Giorgione V, Ridder A, Kalafat E, Khalil A, Thilaganathan B. Incidence of postpartum hypertension within 2 years of a pregnancy complicated by pre-eclampsia: a systematic review and meta-analysis. BJOG 2021;128:495-503.
Goel A, Maski MR, Bajracharya S, Wenger JB, Zhang D, Salahuddin S, et al. Epidemiology and mechanisms of De Novo and persistent hypertension in the postpartum period. Circulation 2015;132:1726-33.
Neuman RI, Figaroa AMJ, Nieboer D, Saleh L, Verdonk K, Danser AHJ, et al. Angiogenic markers during preeclampsia: Are they associated with hypertension 1 year postpartum? Pregnancy Hypertens 2021;23:116-22.
Lopes van Balen VA, Spaan JJ, Cornelis T, Heidema WM, Scholten RR, Spaanderman MEA. Endothelial and kidney function in women with a history of preeclampsia and healthy parous controls: a case control study. Microvasc Res 2018;116:71-6.
Hauspurg A, Countouris ME, Jeyabalan A, Hubel CA, Roberts JM, Schwarz EB, et al. Risk of hypertension and abnormal biomarkers in the first year postpartum associated with hypertensive disorders of pregnancy among overweight and obese women. Pregnancy Hypertens 2019;15:1-6.
El Mokadem MO, Hady YAE, Yaquob SM, Fahim AS. Short term cardiovascular risk in normotensive women after hypertensive pregnancy. Hipertens Riesgo Vasc 2021;38:56-62.
Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S, et al. The hypertensive disorders of pregnancy: ISSHP classification, diagnosis & management recommendations for international practice. Pregnancy Hypertens 2018;13:291-310.
Magee LA, Brown MA, Hall DR, Gupte S, Hennessy A, Karumanchi SA, et al. The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice. Pregnancy Hypertens 2022;27:148-69.
Moe K, Sugulle M, Dechend R, Staff AC. Risk prediction of maternal cardiovascular disease one year after hypertensive pregnancy complications or gestational diabetes mellitus. Eur J Prev Cardiol 2020;27:1273-83.
Liabsuetrakul T, Thida T. Geographical distribution of hypertensive disorders in pregnancy and their adverse maternal and perinatal outcomes in Thailand. Int J Pregn Chi Birth 2017;2:42-3.
Brown MA, Lindheimer MD, de Swiet M, Van Assche A, Moutquin JM. The classification and diagnosis of the hypertensive disorders of pregnancy: statement from the International Society for the Study of Hypertension in Pregnancy (ISSHP). Hypertens Pregnancy 2001;20:IX-XIV.
World Health Organization. Global physical activity surveillance [homepage on the Internet]. Geneva: WHO; 2013 [cited 2021 May 7]. https://www.who.int/publications/m/item/global-physical-activity-questionnaire
Methipisit T, Mungthin M, Saengwanitch S, Ruangkana P, Chinwarun Y, Ruangkanchanasetr P, et al. The development of sleep questionnaires Thai version (ESS, SA-SDQ, and PSQI): linguistic validation, reliability analysis and cut-off level to determine sleep related problems in Thai population. J Med Assoc Thai 2016;99:893-903.
Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193-213.
World Health Organization, Regional Office for the Western Pacific. The Asia-Pacific perspective: redefining obesity and its treatment [homepage on the Internet]. Sydney: Health Communications Australia; 2000 [cited 2022 January 5]. https://apps.who.int/iris/handle/10665/206936
Stergiou GS, O’Brien E, Myers M, Palatini P, Parati G; STRIDE BP Scientific Advisory Board. STRIDE BP: an international initiative for accurate blood pressure measurement. J Hypertens 2020;38:395-99.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 2003;42:1206-52.
R core team. R: A language and environment for statisticalcomputing. Vienna: R Foundation for Statistical Computing; 2021.
Escouto DC, Green A, Kurlak L, Walker K, Loughna P, Chappell L, et al. Postpartum evaluation of cardiovascular disease risk for women with pregnancies complicated by hypertension. Pregnancy Hypertens 2018;13:218-24.
Babah OA, Olaleye O, Afolabi BB. Postpartum sequelae of the hypertensive diseases of pregnancy: a pilot study. Niger Med J 2018;59:1-6.
Smith GN, Walker MC, Liu A, Wen SW, Swansburg M, Ramshaw H, et al. A history of preeclampsia identifies women who have underlying cardiovascular risk factors. Am J Obstet Gynecol 2009;200:58.e1-8.
Ehrenthal DB, Rogers S, Goldstein ND, Edwards DG, Weintraub WS. Cardiovascular risk factors one year after a hypertensive disorder of pregnancy. J Womens Health (Larchmt) 2015;24:23-9.
Melchiorre K, Sutherland GR, Liberati M, Thilaganathan B. Preeclampsia is associated with persistent postpartum cardiovascular impairment. Hypertension 2011;58:709-15.
Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, et al. 2020 International Society of Hypertension global hypertension practice guidelines. J Hypertens 2020;38:982-1004.
Lin CC, Kardia SL, Li CI, Liu CS, Lai MM, Lin WY, et al. The relationship of high sensitivity C-reactive protein to percent body fat mass, body mass index, waist-to-hip ratio, and waist circumference in a Taiwanese population. BMC Public Health 2010;10:579.
McDonald SD, Han Z, Walsh MW, Gerstein HC, Devereaux PJ. Kidney disease after preeclampsia: a systematic review and meta-analysis. Am J Kidney Dis 2010;55:1026-39.
Podymow T, August P. Postpartum course of gestational hypertension and preeclampsia. Hypertens Pregnancy 2010;29:294-300.
Lewington S, Clarke R, Qizilbash N, Peto R, Collins R; Prospective studies collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002;360:1903-13.
Refbacks
- There are currently no refbacks.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.