Preconception CV Risk Factors Explored for Gestational Hypertension, Preeclampsia

Pam Harrison

April 29, 2016

OSLO, NORWAY — Gestational hypertension and preeclampsia share several preconception risk factors, some of which could be modified to reduce the risk of adverse pregnancy outcomes, suggests a cohort study covering >13,000 pregnancies[1].

"Our findings support the hypotheses that pregnancy unmasks predisposing familial and modifiable cardiometabolic risk," write the authors, led by Dr Grace M Egeland (Norwegian Institute of Public Health & University of Bergen), in their report published April 25, 2016 in Hypertension. "However, in the current study, a greater number of risk factors predicted preeclampsia than gestational hypertension."

A family history of diabetes and women's own diabetes status prior to conception predicted both gestational hypertension and preeclampsia among participants in the Cohort Norway (CONOR) health survey, which ran from 1994 to 2003.

A family history of MI before age 60 also predicted preeclampsia, but it didn't predict gestational hypertension. A family history of stroke predicted the combined outcome of gestational hypertension or preeclampsia.

A total cholesterol/HDL-cholesterol ratio exceeding 5 predicted both gestational hypertension and preeclampsia; but elevated triglycerides (≥1.7 mmol/L) was a predictor only for preeclampsia, according to the group. Obesity turned out to be an important risk factor for both adverse pregnancy outcomes.

Women determined to be at increased risk for an adverse pregnancy outcome require more frequent screening as the pregnancy progresses, to ascertain whether or not they are in the unlucky zone, observed Dr Christopher Redman (Oxford University, UK) for heartwire from Medscape.

"The question is: Could these risk factors be modified in advance of pregnancy?" he asked, referring the analysis findings. "And they can—obesity is the primary example—it's not known for sure, but everything points to the fact that if a woman can bring her [body-mass index] BMI down into the normal zone, she'll reduce her risk of having preeclampsia and gestational hypertension."

Redman, long a leading figure in obstetric medicine, isn't connected with the current analysis.

Certainly, he said, a woman planning a pregnancy and meeting with her doctor would benefit from being informed of important risks for adverse pregnancy outcomes. "One of the major issues women raise after they've been through preeclampsia—not so much gestational hypertension, which is usually a milder situation—is: Why didn't anybody warn me? I had no idea that this could happen."

Preconception Risk Factors for Hypertensive Disorders of Pregnancy, Odds Ratio (95% CI)

Risk factor Gestational hypertension Preeclampsia
Family history of diabetes 2.1 (1.39–3.09) 1.6 (1.12–2.25)
Stroke 1.5 (0.85–2.55) 1.5 (0.95–2.24)
MI before 60 1.1 (0.69–1.70) 1.8 (1.31–2.39)
Prepregnancy diabetes 3.2 (1.14–8.68) 3.1 (1.43–6.49)
Weekly alcohol consumption 0.8 (0.40–1.42) 0.5 (0.27–0.78)
Binge drinking ≥6 times past year 1.2 (0.65–2.12) 1.8 (1.09–2.94)

In other findings from the study, physical activity for 3 hours a week or more reduced the risk of preeclampsia by 20% and the risk of preterm preeclampsia by 50%. But physical activity is not protective against gestational hypertension, the analysis suggests.

Weekly alcohol consumption emerged as similarly protective against preeclampsia. Compared with no alcohol consumption or consumption of less than one serving per month, weekly alcohol consumption prior to conception was associated with a 30% lower risk of both preeclampsia and term preeclampsia.

On the other hand, binge drinking increased the risk of preeclampsia almost twofold and it increased the risk of preterm preeclampsia almost fourfold.

Adjusted for binge drinking, weekly alcohol consumption also reduced the risk of preeclampsia by 50%, and its protective effect was even stronger for preterm preeclampsia.

Redman said that pharmacologic correction of dyslipidemia is a tricky thing to recommend in the context; physicians are reluctant to prescribe a statin out of concern for effects on the developing fetus.

Neither the study's authors nor Redman had conflicts to disclose.

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