Hypertensive disorders of pregnancy and gestational diabetes mellitus and predicted risk of maternal cardiovascular disease 10-14 years after delivery: A prospective cohort.

Aims: Studies evaluating the relationship between adverse pregnancy outcomes (APOs), namely hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM), with the estimated risk of atherosclerotic cardiovascular disease (ASCVD) remains limited and could inform patient-centred decision-making in the postpartum period. We examined whether HDP or GDM were associated with a higher 10- and 30-year predicted risk of ASCVD measured 10-14 years after delivery.

Methods: A secondary analysis from the international prospective Hyperglycemia and Adverse Pregnancy Outcome Follow-up Study (2013-2016) cohort. The exposures were HDP or GDM (untreated according to the International Association of the Diabetes and Pregnancy Study Groups criteria). Outcomes were 10- and 30-year predicted risk of ASCVD (composite of fatal and non-fatal coronary heart disease and stroke) as quantified by the validated Framingham Risk Score as a continuous measure, and secondarily, at thresholds used for clinical decision-making of ≥7.5% for 10-year predicted risk and ≥20% for 30-year predicted risk.

Results: Of 4432 individuals at a median age of 30.5 years and a median gestational age of 27.9 weeks at pregnancy enrollment, 10.7% developed HDP and 13.7% developed GDM. At 10-14 years after delivery, individuals with HDP had a higher 10-year predicted risk of ASCVD (least squares mean: 2.9% vs. 2.2%; adj. β: 0.59; 95% CI: 0.41-0.77) and a higher 30-year predicted risk of ASCVD (7.7% vs. 6.1%; adj. β: 1.27; 95% CI: 0.81-1.72) compared with those without HDP. Similarly, individuals with GDM had a higher predicted risk of ASCVD (10-year: 3.2% vs. 2.1%; adj. β: 0.51; 95% CI: 0.34-0.67 and 30-year: 8.8% vs. 5.8%; adj. β: 1.56; 95% CI: 1.11-2.01) compared with those without GDM. These results were similar when predicted ASCVD risk was assessed at thresholds of ≥7.5% at 10 years and ≥20% at 30 years.

Conclusion: Individuals who experienced HDP or GDM had a higher predicted 10- and 30-year risk of ASCVD measured 10-14 years after delivery compared with individuals who did not experience these APOs.