Table 2.
Hypertensive Disorders in First Pregnancy and Cardiovascular Disease
| Hypertensive Disorder in First Pregnancy Status | ||||
|---|---|---|---|---|
| Normotensive Pregnancy n=54,756 (90.7%) | Gestational Hypertension n=1,789 (3.0%) | Preeclampsia n=3,834 (6.4%) | Hypertensive Disorders of Pregnancy n=5,623 (9.3%) | |
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| CVD (CAD or Stroke) | ||||
| Cases/Person-Years | 920/1,885,474 | 41/57,900 | 113/128,840 | 154/186,740 |
| Excess cases per 100,000 person-years | --- | 22 | 39 | 34 |
| Median age at event (IQR), years* | 56 (50, 62) | 58 (52, 63) | 55 (47, 60) | 56 (48, 62) |
| Median time to event (IQR), years* | 35 (29, 40) | 32 (27, 37) | 34 (29, 39) | 33 (28, 38) |
| Model 1 | 1.00 (ref) | 1.55 (1.13, 2.12) | 1.87 (1.54, 2.28) | 1.78 (1.50, 2.11) |
| Model 2 | 1.00 (ref) | 1.41 (1.03, 1.93) | 1.72 (1.42, 2.10) | 1.63 (1.37, 1.94) |
| CAD | ||||
| Cases/Person-Years | 467/1,831,185 | 19/56,130 | 74/125,080 | 93/181,210 |
| Excess cases per 100,000 person-years | --- | 8 | 34 | 26 |
| Median age at event (IQR), years* | 56 (51, 61) | 61 (55, 65) | 55 (47, 61) | 57 (50, 62) |
| Median time to event (IQR), years* | 34 (28, 39) | 31 (26, 36) | 33 (28, 38) | 32 (27, 37) |
| Model 1 | 1.00 (ref) | 1.42 (0.90, 2.25) | 2.42 (1.90, 3.10) | 2.12 (1.70, 2.65) |
| Model 2 | 1.00 (ref) | 1.27 (0.80, 2.02) | 2.21 (1.73, 2.84) | 1.93 (1.54, 2.41) |
| Stroke | ||||
| Cases/Person-Years | 454/1,831,172 | 22/56,133 | 39/125,045 | 61/181,178 |
| Excess cases per 100,000 person-years | --- | 14 | 6 | 9 |
| Median age at event (IQR), years† | 57 (50, 62) | 56 (52, 62) | 54 (48, 60) | 55 (48, 61) |
| Median time to event (IQR), years† | 34 (28, 39) | 31 (26, 36) | 33 (28, 38) | 32 (27, 37) |
| Model 1 | 1.00 (ref) | 1.67 (1.09, 2.56) | 1.29 (0.93, 1.80) | 1.41 (1.08, 1.84) |
| Model 2 | 1.00 (ref) | 1.56 (1.01, 2.40) | 1.21 (0.87, 1.68) | 1.32 (1.00, 1.73)‡ |
CAD: coronary artery disease; CVD: cardiovascular disease; IQR: interquartile range. Values are HR and 95% CI unless otherwise indicated. Excess cases (rate differences) were calculated by subtracting the incidence (cases/person-years) in the unexposed from the incidence in the exposed.
Model 1 is adjusted for age at first birth (years), age at NHSII enrollment (years), race/ethnicity (Black, Hispanic/Latina, Asian, White [ref], other/multi-race), and parental education (<9, 9–11, 12, 13–15, ≥16 years [ref]).
Model 2 is additionally adjusted for physical activity at ages 18–22 (never, 1–3 [ref], 4–6, 7–9, 10–12 mo/yr), pre-pregnancy smoking (never [ref], past, current), pre-pregnancy BMI (<18.5, 18.5–24.9 [ref], 25–29.9, ≥30 kg/m2), pre-pregnancy alcohol consumption (none [ref], ≤1 drink/week, 2–6 drinks/week, ≥1 drink/day), pre-pregnancy Alternative Healthy Eating Index (AHEI) score (quintiles with the fifth quintile [ref] representing the healthiest diet category), pre-pregnancy oral contraceptive use (never [ref], <2, 2–<4, ≥4 years), pre-pregnancy hypercholesterolemia (no [ref], yes), and parental history of CAD and/or stroke before age 60 (CAD only for CAD model, stroke only for stroke model, CAD or stroke for CVD models; no [ref], yes)
P-value <0.0001 from a global test of the difference in the distribution of age at/time to CVD event between hypertensive disorder in first pregnancy exposure groups
P-value <0.05 from a global test of the difference in the distribution of age at/time to CVD event between hypertensive disorder in first pregnancy exposure groups
The hazard ratio for the association between stroke and hypertensive disorders of pregnancy was statistically significant (p=0.0467; CI: 1.004–1.726)