Abstract MP46: Recurrent Hypertensive Disorders of Pregnancy and Subsequent Maternal Coronary Heart Disease and Stroke

Introduction: Hypertensive disorders of pregnancy (HDP) complicate 5-10% of pregnancies and lead to maternal morbidity and mortality. Prior HDP increases HDP risk in subsequent pregnancies with little known about coronary heart disease (CHD) and stroke in recurrent HDP. We aimed to assess the relationship between recurrent HDP and subsequent CHD and stroke. Methods: This retrospective cohort study included women aged 12-49 with one or more singleton, live birth in South Carolina from 2004-2016. Deliveries were evaluated for HDP (preeclampsia, eclampsia, gestational hypertension) defined by birth certificate and/or hospitalization/emergency department (ED) visit data. Women were classified as having no, one, or two or more pregnancies with HDP. Hospitalization/ED visit and death certificate data defined incident CHD and stroke. Extended Cox models with time varying covariates were used to evaluate the association of recurrent HDP with CHD and stroke controlling for sociodemographic, behavioral, and clinical characteristics. Results: The 163,598 women (non-Hispanic White (NHW; 57.8%), non-Hispanic Black (NHB; 33.9%), and Hispanic (8.3%) had two or more (3.3%), one (12.0%), or no (84.7%) HDP pregnancies. Women with recurrent HDP were more likely to develop subsequent CHD or stroke after covariable adjustment (Table 1). Having one or two or more HDP pregnancies compared with no HDP pregnancies increased the subsequent risk of CHD (HR=2.25; 95% CI: 1.97-2.56 and HR=2.98; 95% CI: 2.43-3.67, respectively). Having one or two or more HDP pregnancies compared with no HDP pregnancies increased the subsequent risk of stroke (HR=2.05; 95% CI: 1.61-2.61 and HR=2.97; 95% CI: 2.04-4.32, respectively). Discussion: Women with recurrent HDP are at higher risk of subsequent CHD and stroke. Higher incident CHD and stroke risk appears to persist into the next pregnancy with accumulated HDP conferring higher risk.