Maternal risk of hypertension 7–15 years after pregnancy: clues from the placenta. (9th October 2020)

• Record Type: Journal Article
• Authors: Holzman, CB; Senagore, P; Xu, J; Dunietz, GL; Strutz, KL; Tian, Y; Bullen, BL; Eagle, M; Catov, JM
• Is Part Of: BJOG. Volume 128:Number 5(2021)
• Page Start: 827
• Page End: 836
• Publication Date: 2020-10-09
• Subjects: Epidemiology: general obstetrics -- maternal physiology -- medical disorders in pregnancy -- placental pathology -- risk management -- translational research; Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1111/1471-0528.16498
• Languages: English
• ISSNs: 1470-0328

Abstract

Abstract : 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. Tweetable Abstract: Placental findings associated with mother's risk of later‐life hypertension.