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Maternal risk of hypertension 7–15 years after pregnancy: clues from the placenta
Author(s) -
Holzman CB,
Senagore P,
Xu J,
Dunietz GL,
Strutz KL,
Tian Y,
Bullen BL,
Eagle M,
Catov JM
Publication year - 2021
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.16498
Subject(s) - medicine , pregnancy , odds ratio , obstetrics , gestational hypertension , cohort , hypertension in pregnancy , blood pressure , prospective cohort study , gestation , preeclampsia , gynecology , genetics , biology
Objective To assess whether pre‐eclampsia (PE)‐related placental/extraplacental membrane findings are linked to moderately elevated blood pressure (BP) in pregnancy and later‐life hypertension. Design Prospective cohort. Setting 52 prenatal clinics, 5 Michigan communities. Sample The POUCH Study recruited women at 16–27 weeks’ gestation (1998–2004) and studied a sub‐cohort in depth. This sample ( n = 490) includes sub‐cohort women with detailed placental assessments and cardiovascular health evaluations 7–15 years later in the POUCHmoms follow‐up study. Methods PE‐related placental/extraplacental membrane findings (i.e. mural hyperplasia, unaltered/abnormal vessels or atherosis in decidua; infarcts) were evaluated in relation to pregnancy BP and odds of Stage 2 hypertension at follow up using weighted polytomous regression. Follow‐up hypertension odds also were compared in three pregnancy BP groups: normotensives (referent) and moderately elevated BP with or without PE‐related placental/extraplacental membrane findings. Main outcome measures Stage 2 hypertension (SBP ≥140 mmHg and/or DBP ≥90 mmHg, or using antihypertensive medications) at follow up. Results After excluding women with pregnancy hypertension (i.e. chronic, PE, gestational), mural hyperplasia and unaltered/abnormal decidual vessels were each associated with Stage 2 hypertension at follow up: adjusted odds ratio (aOR) = 2.7, 95% CI 1.1–6.6, and aOR = 1.7 (95% CI 0.8–3.4), respectively. Women with moderately elevated BP in pregnancy and evidence of mural hyperplasia or unaltered/abnormal decidual vessels had greater odds of Stage 2 hypertension at follow up: aOR = 4.5 (95% CI 1.6–12.5 and aOR = 2.6, 95% CI 1.1–5.9, respectively. Conclusions PE‐related placental/extraplacental membrane findings help risk‐stratify women with moderately elevated BP in pregnancy for later development of hypertension. Tweetable Abstract Placental findings associated with mother’s risk of later‐life hypertension.