(678) Risk of hypertension 2-7 years after delivery by timing of hypertensive disorder of pregnancy

We sought to assess whether the timing of onset of a hypertensive disorder of pregnancy (HDP) was related to the risk of incident hypertension 2-7 years after delivery.

Study Design: This is a secondary analysis of the NuMoM2b-Heart Health Study (NuMoM2b-HHS), a multi-site cohort that enrolled nulliparous pregnant individuals in their first trimester who were followed during pregnancy and subsequently underwent a cardiovascular screening visit at 2-7 years after delivery. For this analysis, we excluded individuals with pre-pregnancy chronic hypertension. We compared rates of hypertension (blood pressure ≥130/80 mmHg or use of anti-hypertensive medications) at the 2-7 year postpartum study visit based on timing of onset of HDP (categorized as antepartum, intrapartum, postpartum) versus no HDP (referent). Multivariable logistic regression models adjusted for baseline covariates (age, insurance, tobacco use, diabetes, and early pregnancy body mass index). Interaction analysis was performed to evaluate effect modification by the presence of severe features of HDP.

Results:

Of 4,342 individuals included in this analysis, 23% had a HDP and underwent follow up at a mean of 3.2± 0.9 years after their first birth. Hypertension at follow up was more prevalent among those with antepartum (37.6%) or postpartum HDP (40.0%) compared to those with intrapartum HDP (26.0%) or no HDP pregnancies (16.5%). Compared to those with non-HDP pregnancies, those with HDP had higher odds of incident hypertension at follow up regardless of the timing of onset (Table). Findings were similar regardless of the presence of severe features (interaction p=0.56).

Conclusion: Individuals with HDP, regardless of whether it is diagnosed antepartum, intrapartum or postpartum appear to have similarly increased odds of incident hypertension at 2-7 years postpartum, compared with individuals without HDP in their first birth.