Adding pregnancy-related factors improved the prediction of 10-year incident hypertension in women after pregnancy compared to standard factors alone (C-index difference 0.113; 95% CI 0.092-0.132).
Cohort (n=28,234)
Yes
Does a prediction model including pregnancy-related factors improve the prediction of 10-year incident hypertension in women after pregnancy compared to a model with only sociodemographic and CVD-related factors?
Incorporating pregnancy-related factors such as hypertensive disorders of pregnancy and preterm birth significantly improves the prediction of 10-year incident hypertension in women after their first delivery.
Effect estimate: C-index difference 0.113 (95% CI 0.092 - 0.132)
Abstract Background/Introduction Pregnancy-related factors identify women with a high cardiovascular risk early in the life course, providing a window of opportunity to start cardiovascular risk management to improve women’s cardiovascular health and prevent or delay the development of cardiovascular disease (CVD). Purpose The aim of this study was to develop a model including pregnancy-related factors for the prediction of incident hypertension after pregnancy and to assess the impact of pregnancy-related factors on model performance. Methods Analyses were based on routine primary care data linked to the national perinatal registry and data from the national statistics bureau. Women with a first delivery at ≥ 24 weeks’ gestation between 2007-2019 were included and were followed until the development of hypertension (i.e., the primary outcome measure), 10 years of follow-up, maternal mortality, deregistration from the primary care data, or 31 December 2022, whichever came first. Two Cox proportional hazards models were developed to estimate the 10-year risk of hypertension. Model 1 included sociodemographic factors and CVD-related factors, while model 2 additionally included pregnancy-related factors. Results We included 28,234 women, of which 639 (2.3%) developed hypertensions. The cumulative 10-year incidence of hypertension was 3.3% in the overall population, 5.8% in women with preterm birth, 11.9% in women with gestational hypertension, and 17.2% in women with (pre-)eclampsia. The increased risk was more striking in the years immediately after pregnancy. Higher risks of hypertension were also found in women with a migration background and low household disposable income (Figure 1). The C-index of model 1 and model 2 were 0.659 (95% CI: 0.642 - 0.684) and 0.772 (95% CI: 0.754 - 0.796), respectively. The C-index difference was 0.113 (95% CI: 0.092 - 0.132), which was mostly driven by the inclusion of hypertensive disorders of pregnancy and preterm birth (Table 1). Both models were well-calibrated. After adjusting for optimism, the C-index of model 2 was 0.764 (95% CI: 0.737 - 0.799), indicating only marginal overfitting. Net reclassification improvement was 0.318 (95% CI: 0.254 - 0.375) for events and 0.001 (95% CI: -0.021 - 0.025) for non-events. Conclusion(s) This is the first study to develop a prediction model for the 10-year risk of hypertension in women after pregnancy, incorporating sociodemographic factors, CVD-related factors, and pregnancy-related factors. The addition of pregnancy-related factors resulted in an improvement in predictive ability. This model may help to identify women at high risk of hypertension after pregnancy more precisely, which allows healthcare providers to better utilize the period directly after pregnancy as a window of opportunity to start cardiovascular risk management, ultimately alleviating the cardiovascular burden in women.Figure 1.Hazard ratio and 95% CIFor image description, please refer to the figure legend and surrounding text. Table 1.Discrimination statisticsFor image description, please refer to the figure legend and surrounding text.
Yang et al. (Mon,) conducted a cohort in incident hypertension after pregnancy (n=28,234). Pregnancy-related factors vs. Sociodemographic and CVD-related factors alone was evaluated on development of hypertension (C-index difference 0.113, 95% CI 0.092 - 0.132). Adding pregnancy-related factors improved the prediction of 10-year incident hypertension in women after pregnancy compared to standard factors alone (C-index difference 0.113; 95% CI 0.092-0.132).