The intricate dance between pregnancy and the cardiovascular system has long fascinated researchers, offering a glimpse into the body’s remarkable ability to adapt and sustain life. However, for a subset of individuals, this physiological ballet can turn into a dangerous tightrope walk, marked by hypertensive disorders of pregnancy (HDP) that pose significant risks to maternal health. A recent study conducted by researchers at the University of Bergen sheds new light on the association between HDP and long-term cardiovascular outcomes, revealing a complex interplay that defies one-size-fits-all explanations.
Led by Sage Wyatt, a PhD candidate at the Department of Global Public Health and Primary Care, the HealthierWomen Project at the University of Bergen seeks to unravel the intricate relationship between women’s reproductive history and later health outcomes. Previous research within the project, led by Associate Professor Liv Kvalvik, has already delved into the predictive value of pregnancy complications for cardiovascular disease (CVD) mortality at age 40. Wyatt’s focus has been on elucidating how HDP may serve as a predictor for stroke and heart attack in later life.
The prevailing hypothesis posits that HDP may serve as a harbinger of underlying chronic CVD, manifesting during the “stress-test” of pregnancy. Traditionally, studies examining the association between HDP and long-term CVD risk have focused on the relationship between a single occurrence of HDP and subsequent cardiovascular outcomes. However, Wyatt and her colleagues sought to delve deeper, recognizing that individuals are not defined by a singular pregnancy but rather by their unique lifetime history of HDP.
Leveraging the robust birth registry and public healthcare system in Norway, the researchers meticulously examined the order and severity of HDP across multiple pregnancies. Contrary to previous estimates, which suggested a doubling of the risk of heart attack and stroke associated with HDP, Wyatt’s findings revealed a striking variability in risk, with some individuals facing an almost ten-fold increase in risk.
Notably, individuals with a rare pattern characterized by multiple instances of severe HDP, often resulting in preterm delivery, emerged as high-risk cohorts. In contrast, those with a more common pattern, featuring a single occurrence of HDP with uncomplicated subsequent pregnancies, exhibited minimal to no increase in CVD risk.
Furthermore, Wyatt’s analysis underscored the inadequacy of previous approaches that amalgamated all patterns of HDP into a singular variable, obscuring the nuanced risks faced by both low and high-risk individuals. Even individuals who experienced HDP in only one pregnancy, as well as those with fewer children overall, demonstrated elevated risk for heart attack and stroke compared to their counterparts.
This nuanced understanding of the relationship between HDP and long-term cardiovascular outcomes underscores the multifactorial nature of CVD risk prediction, emphasizing the importance of considering individualized factors across a woman’s reproductive history. Wyatt’s research advocates for a shift from blanket screening and interventions based solely on a history of HDP to a more holistic approach that integrates diverse factors shaping each pregnant person’s unique journey.
As Wyatt aptly summarizes, “Every pregnant person is unique.” By acknowledging this individuality and embracing a more nuanced understanding of HDP, researchers and healthcare providers can pave the way for tailored interventions that address the complex interplay between pregnancy and cardiovascular health, ensuring better outcomes for women across their reproductive lifespans.
