Background:
Women who have had preeclampsia are at greater risk of long term cardiovascular disease with increased risks of hypertension, stroke and myocardial infarction (1,2,3). Less is known about the effects on the woman’s mental health and the outcomes for their infants.
Design:
300 women who were normotensive in the preceding pregnancy, 100 who had preeclampsia and 100 who had gestational hypertension will be recruited. The cardiovascular and psychological health of the women and the physical and developmental health of their infants will be assessed at six months and two and five years after birth. The primary outcome is the percentage of women with hypertensive pregnancies who have average ABPM measures >2SD above the mean for women with normotensive pregnancies.
Results:
To date 194 women have been recruited and 175 have had their six month Assessment. Amongst 127 normals and 31 with PE and 7 with GH, 34% of hypertensive women had at least one awake, sleep or 24hr average ABPM measure >2 SD above the mean (p<0.001). They also had a higher mean BMI (28 vs 25, p=0.023) and fasting insulin (10 vs 6 mU/L, p=0.001) and evidence of cardiac diastolic dysfunction with a lower mean E/A ratio (1.4 vs 1.8, p=0.007). They had more symptoms of PTSD (26 vs 15%, NS) and results of other psychological testing were slightly higher. Their infants performed slightly better in the social domain of the maternally reported Ages and Stages Questionnaire (50 vs 45, p=0.027) but otherwise scores were similar between groups.
Conclusions:
These six month data show that women with hypertensive pregnancies have higher BP and other evidence of the metabolic syndrome and possibly features of PTSD. Other psychological morbidity is not significantly affected and the health and development of their infants are unaffected. Establishing new limits of normal BP in this cohort of young women is key to identifying future cardiovascular risk in those who had hypertensive pregnancies.