Poster Session 4
Praveen Ramesh, MD (he/him/his)
Fellow, Maternal-Fetal Medicine
Magee-Women's Hospital of UPMC
Pittsburgh, PA, United States
Malamo Countouris, MD
Assistant Professor of Medicine, Department of Cardiology
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania, United States
Arun Jeyabalan, MD, MS (she/her/hers)
Division Director of Maternal-Fetal Medicine
University of Pittsburgh School of Medicine
Pittsburgh, Pennsylvania, United States
Alisse Hauspurg, MD (she/her/hers)
Assistant Professor
Alpert Medical School of Brown University
Providence, RI, United States
Hypertensive disorders of pregnancy (HDP) are associated with future cardiovascular (CV) risk, likely mediated through development of chronic hypertension (CHTN). We sought to assess if development of interpregnancy CHTN following a pregnancy complicated by an HDP was associated with adverse outcomes in the subsequent pregnancy.
Study Design:
This is a cohort study of individuals with consecutive pregnancies with an index pregnancy complicated by an HDP. We compared demographics and outcomes in the subsequent pregnancy between those who developed interpregnancy CHTN with those who had blood pressure (BP) normalization. We included patients with a known diagnosis of CHTN and those who had 2 or more BPs ≥ 140/90 mmHg prior to 20 weeks. The primary outcome was preterm birth < 37 weeks (PTB). Secondary outcomes included a small-for-gestational age (SGA) newborn and recurrent pre-eclampsia. The association of all outcomes with interpregnancy CHTN was adjusted for age, BMI, and maternal self-identified race (as a social construct) via multivariable logistic regression.
Results:
We included 4,437 individuals with an HDP during the index pregnancy. 523 (11.8%) developed interpregnancy CHTN. Individuals who developed interpregnancy CHTN were older, more likely to identify as Black race, had a higher index pregnancy BMI, and were more likely to have had preeclampsia with severe features in the index pregnancy compared to those with BP normalization (Table 1). Those who developed interpregnancy HTN were more likely to have a preterm birth, (19.5% vs.11%; aOR 2.25; 95% CI 1.66-3.04, p< 0.001), an SGA newborn (14.2% vs. 8.3%; aOR 2.48; 95% CI 1.76-3.48, p< 0.001) and develop recurrent pre-eclampsia (22.2% vs.12.6; aOR 2.27; 95% CI 1.70-3.04, p< 0.001) in the subsequent pregnancy compared to those with BP normalization.
Conclusion:
Individuals with interpregnancy development of CHTN after an HDP have an increased odds of adverse pregnancy outcomes compared to those with BP normalization. Postpartum interventions to reduce the risk of interpregnancy CHTN may improve long-term CV health and future pregnancy outcomes.
