Public Release: 

Study shows increased risk of early mortality in women with hypertensive disease

Society for Maternal-Fetal Medicine

ATLANTA (Feb. 1, 2016)--In a study to be presented on Feb. 5 at 8 a.m. EST, at the Society for Maternal-Fetal Medicine's annual meeting, The Pregnancy Meeting™, in Atlanta, researchers will present findings from a study titled, Long-term mortality risk following hypertensive disease of pregnancy (HDP).

It has long been recognized that pregnancy puts considerable stress on the body and that there are specific conditions during pregnancy that will indicate lifelong health issues. The objective of this study was to assess whether women with a history of any hypertensive disease during pregnancy have increased risk for early mortality and to determine the timing and most common cause of their deaths.

The study looked at births from 1939 to 2012 using the Utah Population Database. Based on birth certificate data, researchers assigned a diagnosis of HDP and, when possible, the category of disease (gestational hypertension, preeclampsia, HELLP syndrome--a serious complication of high blood pressure during pregnancy, and eclampsia). Exposed women had a singleton pregnancy complicated by HDP and lived in Utah for more than a year following delivery. Primary cause of death was ascertained from death certificates.

Of 2,083,331 birth certificates evaluated, 61,727 (3%) had HDP. Of these, all-cause mortality was significantly increased for women with a history of HDP. They also had the greatest risk of mortality due to Alzheimer's disease, diabetes, ischemic heart disease, and stroke.

"We now know that women with a history of any category of HDP are at increased risk for mortality from a variety of causes," stated Lauren Theilen, M.D. one of the researchers on the study who will present the findings at the SMFM annual meeting. Dr. Theilen is with the University of Utah Health Sciences Center in Salt Lake City. "It's important for physicians who care for these women beyond their childbearing years to recognize the significance of a history of HDP so that these women may receive appropriate screening and intervention," Theilen added.

The study concluded that women with a history of HDP have increased risk of early mortality with the highest hazard ratios for neurologic, endocrine and circulatory causes. Increased mortality risk for these women begins approximately 20 years after pregnancy.

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A copy of the abstract is available at http://www.smfmnewsroom.org and below. For interviews please contact Vicki Bendure at Vicki@bendurepr.com 202-374-9259 (cell).

The Society for Maternal-Fetal Medicine (est. 1977) is the premiere membership organization for obstetricians/gynecologists who have additional formal education and training in maternal-fetal medicine. The society is devoted to reducing high-risk pregnancy complications by sharing expertise through continuing education to its 2,000 members on the latest pregnancy assessment and treatment methods. It also serves as an advocate for improving public policy, and expanding research funding and opportunities for maternal-fetal medicine. The group hosts an annual meeting in which groundbreaking new ideas and research in the area of maternal-fetal medicine are shared and discussed. For more information visit http://www.smfm.org.

Abstract 45 Long-term mortality risk following hypertensive disease of pregnancy (HDP)

Authors: Lauren Theilen1,2, Alison Fraser3, Michael Hollingshaus4, Karen Schliep1, Michael Varner1,2, Ken Smith3, Sean Esplin1,2
1University of Utah Health Sciences Center, Salt Lake City, UT, 2Intermountain Healthcare, Salt Lake City, UT, 3Huntsman Cancer Institute, Salt Lake City, UT, 4University of Utah, Salt Lake City, UT

Objective: To assess whether women with a history of HDP have increased risk for early mortality, and to determine the timing and most common causes of their deaths.

Study Design: We defined a cohort of births from 1939-2012 using the Utah Population Database. Based on birth certificate data, we assigned a diagnosis of HDP and, when possible, the category of disease [gestational hypertension (GHTN), preeclampsia (PRE), HELLP syndrome, and eclampsia (ECL)]. Exposed women had a singleton pregnancy complicated by HDP and lived in Utah for ?1 year after delivery. Women with >1 pregnancy with HDP were included only once, in the most severe group. Exposed women were matched (1:2) to women without HDP by age, year of childbirth, and parity at time of index pregnancy. Primary cause of death was ascertained from death certificates. Mortality risk by primary cause of death was compared between exposed women (stratified by category of disease) and unexposed women using Cox regression to adjust for infant sex, parental education, ethnicity, and marital status.

Results: Of 2,083,331 birth certificates evaluated, 61,727 (3.0%) unique women had HDP (GHTN 49,438, PRE 29,941, HELLP 921, ECL 1,137) in >1 pregnancy. These women were matched to 123,454 unexposed women. A total of 11,278 women had known death dates: 4,516 (7.3%) exposed and 6,762 (5.5%) unexposed. All-cause mortality was significantly increased among exposed women (HR 1.68, p<0.01) (Table 1). Exposed women had the greatest risk of mortality due to Alzheimer's disease (HR 3.44, p<0.01), diabetes (HR 3.22, p<0.01), ischemic heart disease (HR 2.28, p<0.01), and stroke (HR 1.92, p<0.01). Hazard ratios for causes of mortality varied by category of HDP. Figure 1 illustrates the survival curve in years after the index pregnancy for women with each category of HDP.

Conclusion: Women with a history of HDP have increased risk of early mortality, with highest hazard ratios for neurologic, endocrine, and circulatory causes. Increased mortality risk begins 20 years after the exposed pregnancy.

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