Oral Presentation Society of Obstetric Medicine of Australia and New Zealand ASM 2015

Cardiovascular Health 6 Months Postpartum in Women with Normal and Hypertensive Pregnancies (#40)

Lily Xu 1 2 , Greg Davis 1 2 , Amanda Henry 1 2 , Lynne Roberts 1 3 , George Mangos 4 5 , Franziska Pettit 4 5 , George Youssef 6 , Mark A Brown 4 5
  1. Department of Women’s and Children’s Health, St George Hospital, Kogarah, NSW
  2. School of Women’s and Children’s Health, UNSW Medicine, Sydney, NSW
  3. Faculty of Health, University of Technology, Sydney, NSW
  4. Department of Renal Medicine, St George Hospital, Kogarah, NSW
  5. St George Clinical School, UNSW Medicine, Sydney , NSW
  6. Department of Cardiology, St George Hospital, Kogarah, NSW

Aims:

To establish normal ranges for central and peripheral blood pressure (BP), systemic vascular compliance, and cardiac function 6 months following birth, and compare values in women who had an uncomplicated pregnancy vs. pregnancy complicated by gestational hypertension (GH) or preeclampsia (PE).

Methods:

Prospective cohort of women recruited to the P4 (Postpartum Physiology, Psychology and Paediatric Follow Up) study at St George Hospital from July 2013-June 2015, after either a normal or hypertensive pregnancy (GH or PE) resulting in live birth. At 6 months postpartum, cardiovascular measures included three manual (sphygmomanometer) BP measurements, central BP and augmentation index to assess systemic vascular compliance measured by applanation tonometry, and 24-hr ambulatory BP monitoring (24-hABPM). Cardiac function was analysed using transthoracic echocardiography.

Results:

127 women were studied after normotensive pregnancy and 38 after hypertensive pregnancy. Manual, central, and 24-h ABPM were all significantly higher after hypertensive pregnancy (Table). Although only one woman after hypertensive pregnancy had average manual BP ≥140/90mmHg, 11% vs. 0% had high average 24-hABPM (≥130/80mmHg; p<0.001), 8% vs. 1% had high awake ABP (≥135/85mmHg; p=0.015), and 22% vs. 4% had high sleep ABP (≥120/70mmHg; p=0.001) post hypertensive and normotensive pregnancies respectively. 34% of hypertensive women had at least one ABP measure more than 2 SD above that for women who had normotensive pregnancies (p<0.001). Mean augmentation index for hypertensive and normotensive women was similar (17.3% vs. 18.0%). Echocardiographic measurements showed a lower mean E/A ratio between groups, but no significant difference in the proportion of women with abnormal measurements.

Conclusions:

At 6 months postpartum, women who had GH or PE during pregnancy had higher BP compared to women who had a normal pregnancy, particularly evident on 24-hABPM. Importantly, approximately one-third of women who had hypertension in pregnancy have BP outside a new putative normal range for young women at 6 months postpartum. Such knowledge should enable earlier identification of women at increased risk of future CVD morbidity.

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