Hypertensive disorders of pregnancy and long-term risk of incident cardiac arrhythmias: a meta-analysis

Background Hypertensive disorders of pregnancy (HDP) are associated with adverse cardiovascular remodeling and long-term cardiovascular morbidity. Although prior studies demonstrate an increased risk of atrial fibrillation following HDP, the relationship between HDP and overall arrhythmia risk has not been comprehensively evaluated. Purpose To evaluate the association between hypertensive disorders of pregnancy and the long-term risk of incident cardiac arrhythmias, including atrial and ventricular arrhythmias. Methods We conducted a systematic search of PubMed, Scopus, Cochrane Library, and ScienceDirect for studies reporting incident arrhythmias in women with prior HDP through January 2026. Statistical analyses were performed using RevMan 5.4 with a random-effects model to pool hazard ratios (HRs) and 95% confidence intervals (CIs). Heterogeneity was assessed using Higgins I² statistic. Results Our analysis included 10 observational studies including 5.84 million women (mean age at pregnancy 29 years) with follow-up ranging from 2 to 36.2 years postpartum. On pooled analysis, women with prior HDP had a significantly higher risk of overall incident arrhythmia compared with those without HDP (HR 1.59; 95% CI 1.33–1.91; p<0.001; I² = 85%). Sensitivity analyses confirmed the robustness and consistent direction of effect. HDP was also associated with increased risks of atrial fibrillation/flutter (HR 1.66; 95% CI 1.31–2.11; p<0.001; I² = 84%) and ventricular arrhythmias (HR 1.42; 95% CI 1.13–1.80; p=0.003; I² = 0%). Conclusion Women with a history of hypertensive disorders of pregnancy have a significantly increased risk of atrial and ventricular arrhythmias. Recognizing HDP as a sex-specific cardiovascular risk factor may enhance arrhythmic risk stratification and inform targeted preventive strategies.