Maternal coronary heart disease and mortality following hypertensive disorders of pregnancy and/or diabetes.

IF 8.5 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Diabetology Pub Date : 2025-07-11 DOI:10.1186/s12933-025-02811-8

Angela M Malek, Dulaney A Wilson, Julio Mateus, Emily A Ash, Tanya N Turan, Daniel T Lackland, Kelly J Hunt

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引用次数: 0

Abstract

Background: Pre-pregnancy hypertension (HTN), hypertensive disorders of pregnancy (HDP), and diabetes have been linked to increased risk of post-pregnancy coronary heart disease (CHD) and all-cause mortality, but few studies have investigated their cumulative impact. This study aimed to assess the potential relationship between pre-pregnancy HTN, HDP, and diabetes and their cumulative impact on maternal cardiovascular outcomes defined as incident CHD and all-cause mortality within 5 years of delivery and over the entire study period (up to 14 years after delivery).

Methods: This retrospective cohort study included 430,545 women aged 12-49 with ≥ 1 singleton, live birth in South Carolina (2004-2016) including non-Hispanic White (NHW; 59.2%), non-Hispanic Black (NHB; 31.4%), and Hispanic (9.4%) women. Birth certificate and hospitalization/emergency department (ED) visit data defined pre-pregnancy HTN, HDP (preeclampsia, eclampsia, gestational HTN), and diabetes (pre-pregnancy, gestational). Hospitalization/ED visit and death certificate data defined incident CHD and all-cause mortality. Covariate-adjusted Cox proportional hazard models were used to assess associations between CHD and mortality by exposure.

Results: After adjustment for covariates relative to women without any of the three conditions (diabetes, pre-pregnancy HTN, HDP), incident CHD risk was increased within 5 years of delivery for women with diabetes (HR = 1.57; 95% CI 1.28-1.92), HDP (HR = 1.85; 95% CI 1.60-2.15), HDP and diabetes (HR = 2.29; 95% CI 1.73-3.03), HDP and pre-pregnancy HTN (HR = 3.13; 95% CI 2.66-3.68), and all three conditions (HR = 4.87; 95% CI 3.95-6.01). All-cause mortality risk was increased for diabetes (HR = 1.34; 95% CI 1.01-1.78), HDP and pre-pregnancy HTN (HR = 1.53; 95% CI 1.15-2.03), and all three conditions (HR = 2.25; 95% CI 1.51-3.36), but not HDP or HDP and diabetes.

Conclusions: Within 5 years of delivery, incident CHD and all-cause mortality rates were highest for women with two or three conditions, specifically HDP, diabetes, and/or pre-pregnancy HTN, with all rates higher for NHB than NHW women. Thus, it is critical to implement clinical prevention strategies to improve risk factor screening and identification among women of child-bearing age.

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妊娠期高血压疾病和/或糖尿病后的孕产妇冠心病和死亡率。

背景：孕前高血压（HTN）、妊娠高血压疾病（HDP）和糖尿病与妊娠后冠心病（CHD）和全因死亡率风险增加有关，但很少有研究调查其累积影响。本研究旨在评估孕前HTN、HDP和糖尿病之间的潜在关系，以及它们对产妇心血管结局的累积影响，这些结局定义为分娩后5年内和整个研究期间（分娩后长达14年）的冠心病发生率和全因死亡率。方法：本回顾性队列研究纳入430,545名年龄在12-49岁、≥1例单胎活产的南卡罗来纳州妇女（2004-2016），包括非西班牙裔白人(NHW；59.2%)，非西班牙裔黑人(NHB；31.4%)，西班牙裔女性（9.4%）。出生证明和住院/急诊科（ED）就诊数据定义了孕前HTN、HDP（子痫前期、子痫前期、妊娠期HTN）和糖尿病（孕前、妊娠期）。住院/急诊科就诊和死亡证明数据定义了冠心病事件和全因死亡率。使用协变量校正的Cox比例风险模型来评估暴露与冠心病和死亡率之间的关系。结果：相对于没有三种情况（糖尿病、孕前HTN、HDP）的妇女，调整协变量后，糖尿病妇女分娩后5年内发生冠心病的风险增加(HR = 1.57；95% ci 1.28-1.92), HDP (hr = 1.85；95% CI 1.60-2.15)， HDP和糖尿病(HR = 2.29；95% CI 1.73-3.03)、HDP和孕前HTN (HR = 3.13；95% CI 2.66-3.68)，所有三种情况(HR = 4.87；95% ci 3.95-6.01)。糖尿病患者全因死亡风险增加(HR = 1.34；95% CI 1.01-1.78)、HDP和孕前HTN (HR = 1.53；95% CI 1.15-2.03)，所有三种情况(HR = 2.25；95% CI 1.51-3.36)，但HDP或HDP与糖尿病无关。结论：分娩5年内，伴有两种或三种情况的妇女冠心病发生率和全因死亡率最高，特别是HDP、糖尿病和/或孕前HTN，且NHB妇女的发生率均高于NHW妇女。因此，实施临床预防策略以提高育龄妇女的危险因素筛查和识别是至关重要的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cardiovascular Diabetology 医学-内分泌学与代谢

CiteScore

12.30

自引率

15.10%

发文量

240

审稿时长

1 months

期刊介绍： Cardiovascular Diabetology is a journal that welcomes manuscripts exploring various aspects of the relationship between diabetes, cardiovascular health, and the metabolic syndrome. We invite submissions related to clinical studies, genetic investigations, experimental research, pharmacological studies, epidemiological analyses, and molecular biology research in this field.