Recurrent hypertensive disorders of pregnancy and subsequent maternal coronary heart disease, stroke, and all‐cause mortality

Introduction Hypertensive disorders of pregnancy (HDP) complicate 5%–10% of pregancies, to maternal morbidity and mortality. HDP increases the risk of cardiovascular events later in life, but whether repeated HDP episodes confer cumulative risk remains unclear. We aimed to assess the association between recurrent HDP and subsequent maternal coronary heart disease (CHD), stroke, and all‐cause mortality. Methods This retrospective cohort included women aged 12–49 with two or more singleton live births in South Carolina (2004–2016). Deliveries were evaluated for HDP (preeclampsia, eclampsia, gestational hypertension), defined by birth certificate and/or hospitalization/emergency department (ED) visit data. Women had recurrent, one, or no pregnancies with HDP. Outcomes were defined with hospitalization/ED visit and death certificate data. The association of recurrent HDP with CHD, stroke, and mortality were assessed with Cox models incorporating time‐varying covariates. Results Of 163,579 women with two or more pregnancies (59.0% non‐Hispanic White, 32.7% non‐Hispanic Black, and 8.4% Hispanic), 4.8% had more than one (recurrent), one (15.2%), or no (80.0%) HDP pregnancy. CHD incidence rates (per 10,000 person‐years) rose from 7.17 in women with no HDP pregnancies to 18.9 in women with one HDP pregnancy and 36.0 in women with recurrent HDP pregnancies as did stroke incidence rates (2.26, 5.22 and 11.1, respectively). All‐cause mortality rates did not differ by HDP status. After adjustment, compared with women with no HDP pregnancy, the risk of CHD was increased for recurrent HDP (HR, 1.86; 95% CI, 1.51–2.29) and one HDP (HR, 1.72; 95% CI, 1.50–1.97). Stroke risk was also elevated for women with recurrent HDP pregnancies (HR, 1.89; 95% CI, 1.29–2.76) and one pregnancy (HR, 1.62; 95% CI, 1.26–2.09). However, women with recurrent HDP were at similar risk of CHD and stroke when compared to women with one HDP pregnancy. Conclusions CHD and stroke incidence rates roughly doubled with one and two or more HDP pregnancies while all‐cause mortality did not differ. However, while the risks of CHD and stroke were higher in women with recurrent HDP than in women with one HDP pregnancy, the differences were not statistically significant.