November 22, 2011 (Philadelphia, Pennsylvania) — Women with a history of hypertensive pregnancy disorders (HPD) have a significantly higher risk for future hypertension, renal disease, and stroke than women who had normotensive pregnancies, Catherine Brown, MD, from the division of nephrology and hypertension at the Mayo Clinic in Rochester, Minnesota, reported here at Kidney Week 2011: American Society of Nephrology 44th Annual Meeting.
Previous studies of associations between HPD and future morbidities have been limited by small sample sizes, short follow-up, self-reported outcomes, limited numbers of outcomes, and registry-based designs.
Dr. Brown and colleagues used the population-based longitudinal Rochester Epidemiology Project database, which comprises the medical records of residents of Olmstead County, Minnesota, from January 1, 1966 to the present. The database contains information on almost a half million individuals and their approximately 1.2 million medical records from 65 different healthcare providers.
The researchers looked at women in Olmstead County who delivered children from 1976 to 1982 and were classified as having diagnostic codes consistent with HPD (cases) or without HPD (controls). All subjects were followed after 40 years of age for diagnostic codes consistent with adverse cardiovascular and renal outcomes.
For each case woman, a control woman was matched for age, parity, and calendar year who did not have evidence of HPD in that or a previous pregnancy.
The authors identified 6051 mothers who delivered from 1976 to 1982. The mean age of the 607 case women was 26.4 years, and of the 5444 control women was 26.7 years. Follow-up after age 40 was available for 77% (465 of 607) of the case women and 72% (3898 of 5444) of the control women.
The rate of any diagnostic code outcome of interest was 62% in the case women and 47% in the control women. "When you look at the median age at the time of the first event, [for] women who had history of preeclampsia, [the event occurred] on average 6 years prior to those who did not have a history of hypertensive pregnancy disorders. They had higher rates of hypertension, any kind of renal outcome,...and higher risk of stroke," Dr. Brown said.
Outcome Events at 40 Years and Older
| Outcome Event | Cases (n = 465) | Controls (n = 3898) | P value |
| Median age at first event, y (range) | 44 (40–67) | 50 (40–72) | <.0001 |
| Any, n (%) | 288 (62) | 1839 (47) | <.0001 |
| Hypertension, n (%) | 236 (51) | 1222 (31) | <.0001 |
| Renal,* n (%) | 63 (14) | 374 (10) | <.01 |
| Stroke, n (%) | 35 (8) | 160 (4) | <.001 |
There was no significant difference between the case and control groups for the outcomes of coronary heart disease and venous thromboembolism. However, Dr. Brown speculated that the risk for coronary heart disease might have been underestimated because of the age of the cohort.
Delphine Tuot, MD, MAS, assistant professor of nephrology at the University of California at San Francisco, who was not involved in the study, noted that women with HPD should be in yearly contact with a healthcare provider, and said that pregnancy is a "great way" for women to be brought into the healthcare system.
"Many women do not really see their primary care physicians prior to becoming pregnant, so this is a way that we can really intervene and start monitoring them carefully," she said. "We can convey the information that women who do have a complicated pregnancy don't necessarily return to 'normal' after their pregnancy, and that it is important that they continue to see their primary care physician and/or their obstetrician down the road."
She noted that more women with kidney disease are able to get pregnant thanks to improvements in care for chronic kidney disease and in obstetrical care over the past decades. As a result, more women who are at risk for preeclampsia are getting pregnant. "This becomes an even more interesting and more important field moving forward," she said.
There was no commercial funding for the study. Dr. Brown and Dr. Tuot have disclosed no relevant financial relationships.
Kidney Week 2011: American Society of Nephrology 44th Annual Meeting. Abstract TH-OR115. Presented November 10, 2011.
No comments:
Post a Comment