TOPLINE:
Hypertensive disorders of pregnancy (HDP) in first pregnancies significantly increased the risk for dilated cardiomyopathy (DCM), with an early onset of 5.1 years postpartum compared with 10.6 years postpartum in normotensive pregnancies.
METHODOLOGY:
- Researchers conducted this study to investigate whether HDP increase the long-term risk for DCM.
- This cohort study analysed linked electronic health record databases (1997-2018) and compared 14,083 first pregnancies with HDP with 70,415 normotensive control pregnancies in a 5:1 ratio, with follow-up through 2023.
- This study used Clinical Practice Research Datalink (CPRD; Pregnancy Register; Aurum) and hospital/mortality data.
- Participants with HDP had a median age that was 2 years greater than that of those in their first pregnancies without these conditions.
- The primary outcome was incident DCM; secondary outcomes were peripartum cardiomyopathy (PPCM), heart failure, and atherosclerotic cardiovascular disease (ASCVD).
TAKEAWAY:
- HDP were associated with a 93% increased risk for DCM (adjusted hazard ratio [aHR], 1.93; P = .001).
- Moreover, severe preeclampsia was associated with a higher risk for DCM (aHR, 4.09; P < .001), demonstrating a dose-response effect.
- The onset of DCM occurred earlier in participants with HDP than in those without HDP (5.1 vs 10.6 years postpartum).
- Independent risk factors included maternal age (aHR per year of age, 1.06; P < .001) and postpartum incident hypertension (aHR, 1.68; P = .006).
- HDP significantly increased risks for heart failure (aHR, 1.87; P = .001), ASCVD (aHR, 1.48; P < .001), and PPCM (aHR, 4.07; P = .01).
IN PRACTICE:
"[The study] findings support long-term clinical vigilance of patients with a history of hypertensive disorders of pregnancy," the authors wrote.
SOURCE:
This study was led by Upasana Tayal, PhD, National Heart and Lung Institute, Imperial College London, London, United Kingdom. It was published online on April 02, 2025, in JAMA Cardiology.
LIMITATIONS:
CPRD data lacked diversity, limiting broader applicability. Recurrent HDP effects could not be studied due to limited cases, and detection bias was possible as patients with HDP had more heart checks, while asymptomatic DCM may have been missed without routine screening.
DISCLOSURES:
This study was supported by the Medical Research Council and the Royal Society. Several authors reported receiving research grants and fees from various sources outside the submitted work.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
