Women’s Health
Gestational hypertension and risk of cardiovascular disease development in women who have had infants with congenital heart defects in Arkansas, 1997 to 2011 Emine Bircan* Emine Bircan Mohammed Orloff Laura Hays Jun Ying Hari Eswaran Wendy N Nembhard
Preeclampsia and gestational hypertension are common hypertensive pregnancy disorders, with preeclampsia a recognized risk factor for future cardiovascular disease (CVD). Similarly, adverse pregnancy outcomes, including carrying a fetus with congenital heart defects (CHDs), are linked to an increased CVD risk later in life. Women with pregnancies complicated by both CHDs and gestational hypertension may face an elevated CVD risk. This study examines the association between gestational hypertension and CVD risk in women with CHD-affected pregnancies.
Data from the Arkansas site of the National Birth Defects Prevention Study (1997–2011) included 1,423 women with a CHD-affected pregnancy, 1,426 women with a non-CHD birth defect pregnancy, and 1,020 women who delivered infants without structural defects. Maternal sociodemographics, pregnancy complications, and periconceptional risk factors were obtained via telephone interviews. These data were linked to the 2000–2022 Arkansas All-Payers Claims Database to identify subsequent CVD cases. CVD, classified using ICD-9/10-CM codes, included ischemic heart disease, cerebrovascular disease, hypertension, and other heart conditions. Cox proportional hazards models were used to estimate unadjusted and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) based on time to the first CVD event.
Among women with gestational hypertension (n=521), CHD was found no impact on the CVD risk. Among women without gestational hypertension (n=3,348), those with CHD-affected pregnancies had a hazard ratio (HR) of any CVD of 1.4 (95% CI of HR: 1.1–2.1) against women with pregnancies without structural birth defects.
In women with gestational hypertension, CHD-affected pregnancies were not associated with an increased risk of CVD, likely due to the dominant influence of gestational hypertension as a primary risk factor, potentially obscuring additional effects.