DEATH RATES FROM ISCHEMIC-HEART-DISEASE IN WOMEN WITH A HISTORY OF HYPERTENSION IN PREGNANCY

Background. Evidence about the influence of hypertension in pregnancy on later health and in particular the risk of cardiovascular disorders is conflicting, although a link has been suggested. In a population-b ased study with a long follow-up time the potential association betwee n hypertension in pregnancy, preeclampsia and eclampsia with increased death rates from ischemic heart disease (IHD) was investigated. Metho ds. All 7543 case records at the main maternity hospital in Iceland du ring 1931-1947 were reviewed to identify women with hypertension in pr egnancy, subdivided by parity and severity of disease into those with eclampsia, preeclampsia and hypertension alone. Information on those w ho had died was obtained from death certificates, supplemented by auto psy reports and hospital records. Death rates from IHD were compared t o population data from public health and census reports during corresp onding periods and between study groups. Results. Of 374 hypertensive women 177 had died. The death rate was slightly higher among women wit h any hypertension in pregnancy than in the reference population (RR=1 .20; 95% CI 1.01-1.42). About half of the increase was attributed to e xcess mortality from IHD with a relative risk of dying of 1.47 (95% CI 1.05-2.02). The relative risk of dying from II-ID was significantly h igher among eclamptic women (RR=2.61; 95% CI 1.11-6.12) and those with preeclampsia (RR=1.90; 95% CI 1.02-3.52) than those with hypertension alone. Parous women at the index pregnancy had a twofold higher risk of dying from II-ID than primigravid women (RR=2.05; 95% CI 1.19-3.55; p=0.01). Conclusion. There is an indication of increased death rates among women with a history of hypertension in pregnancy, where ischemi c heart disease may be more common than in the general population.