# Subtypes and onset of hypertensive disorders of pregnancy and cardiovascular disease within 5 years after delivery

## TL;DR

This study shows that different types and timing of pregnancy-related high blood pressure disorders are linked to specific cardiovascular risks in the five years after childbirth.

## Contribution

The study identifies distinct cardiovascular disease risk profiles based on the subtype and onset timing of hypertensive disorders of pregnancy.

## Key findings

- Superimposed preeclampsia had the highest risk for stroke, arrhythmia, and peripheral vascular disease.
- Eclampsia showed the strongest link to heart failure, ischemic heart disease, and cardiomyopathy.
- Early-onset disorders generally posed higher CVD risks than late-onset ones.

## Abstract

Hypertensive disorders of pregnancy (HDP) are established predictors of long-term cardiovascular disease (CVD), but the short-term postpartum CVD risk by HDP subtype and onset remains unclear.

We linked electronic health records with vital statistics for 755,606 singleton deliveries in Florida (2012–2017) to examine how different subtypes and onset of HDP are associated with CVD within 5 years postpartum. We classified HDP into six subtypes—chronic hypertension, gestational hypertension, mild preeclampsia, severe preeclampsia, eclampsia, and superimposed preeclampsia - and defined onset as early (<34 weeks) or late (≥34 weeks). Seven CVD outcomes (heart failure, ischemic heart disease, cerebrovascular disease/stroke, arrhythmia/cardiac arrest, cardiomyopathy, peripheral vascular disease, and new-onset chronic hypertension) within five years postpartum were identified. Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) after adjusting for sociodemographic and clinical covariates.

Compared with normotensive pregnancies, superimposed preeclampsia carried the highest risks for stroke (HR 3.39; 95% CI 2.93–3.92), arrhythmia (2.62; 2.25–3.07), and peripheral vascular disease (3.09; 2.67–3.57). Eclampsia showed the strongest associations with heart failure (5.23; 3.70–7.39), ischemic heart disease (3.61; 2.65–4.92), and cardiomyopathy (5.25; 3.37–8.18). Severe preeclampsia was most strongly associated with new hypertension (3.27; 3.10–3.46). Early-onset eclampsia and superimposed preeclampsia showed higher CVD risks than their late-onset counterparts, whereas late-onset gestational hypertension and mild preeclampsia were more strongly associated with new hypertension and cardiomyopathy, respectively.

HDP subtypes and onset timing impart distinct CVD risk profiles within five years postpartum.