Hypertensive disorders of pregnancy and peripartum cardiomyopathy: A nationwide cohort study
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Hypertensive disorders of pregnancy and peripartum cardiomyopathy : A nationwide cohort study. / Behrens, Ida; Basit, Saima; Lykke, Jacob A; Ranthe, Mattis F; Wohlfahrt, Jan; Bundgaard, Henning; Melbye, Mads; Boyd, Heather A.
I: PLoS ONE, Bind 14, Nr. 2, e0211857, 2019.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Hypertensive disorders of pregnancy and peripartum cardiomyopathy
T2 - A nationwide cohort study
AU - Behrens, Ida
AU - Basit, Saima
AU - Lykke, Jacob A
AU - Ranthe, Mattis F
AU - Wohlfahrt, Jan
AU - Bundgaard, Henning
AU - Melbye, Mads
AU - Boyd, Heather A
PY - 2019
Y1 - 2019
N2 - BACKGROUND: Peripartum cardiomyopathy (PPCM) is a serious cardiac disorder occurring late in pregnancy or early in the postpartum period. We examined associations between hypertensive disorders of pregnancy (HDP: preeclampsia and gestational hypertension) and PPCM, accounting for other pregnancy-related risk factors for PPCM.METHODS: Using nationwide Danish register data, we constructed a cohort of all women with ≥1 live birth or stillbirth in Denmark between 1978 and 2012. Using log-linear binomial regression and generalized estimating equations, we estimated risk ratios (RRs) for PPCM associated with HDP of varying severity.RESULTS: In a cohort of 1,088,063 women with 2,078,822 eligible pregnancies, 126 women developed PPCM (39 in connection with an HDP-complicated pregnancy). The risks of PPCM were significantly higher in women with HDP-complicated pregnancies than in women with normotensive pregnancies (severe preeclampsia, RR 21.2, 95% confidence interval [CI] 12.0-37.4; moderate preeclampsia, RR 10.2, 95% CI 6.18-16.9; gestational hypertension, RR 5.16, 95% CI 2.11-12.6). The RRs for moderate preeclampsia and gestational hypertension were not significantly different from one another (p = 0.18); the RR for severe preeclampsia was significantly different from the RR for moderate preeclampsia and gestational hypertension combined (p = 0.02).CONCLUSIONS: Although 70% of PPCM occurred in women with normotensive pregnancies, HDPs were associated with substantial increases in PPCM risk that depended on HDP severity. The heart's capacity to adapt to a normal pregnancy may be exceeded in some women already susceptible to cardiac insult, contributing to PPCM. HDPs, severe preeclampsia in particular, probably represent an additional cardiac stressor during pregnancy.
AB - BACKGROUND: Peripartum cardiomyopathy (PPCM) is a serious cardiac disorder occurring late in pregnancy or early in the postpartum period. We examined associations between hypertensive disorders of pregnancy (HDP: preeclampsia and gestational hypertension) and PPCM, accounting for other pregnancy-related risk factors for PPCM.METHODS: Using nationwide Danish register data, we constructed a cohort of all women with ≥1 live birth or stillbirth in Denmark between 1978 and 2012. Using log-linear binomial regression and generalized estimating equations, we estimated risk ratios (RRs) for PPCM associated with HDP of varying severity.RESULTS: In a cohort of 1,088,063 women with 2,078,822 eligible pregnancies, 126 women developed PPCM (39 in connection with an HDP-complicated pregnancy). The risks of PPCM were significantly higher in women with HDP-complicated pregnancies than in women with normotensive pregnancies (severe preeclampsia, RR 21.2, 95% confidence interval [CI] 12.0-37.4; moderate preeclampsia, RR 10.2, 95% CI 6.18-16.9; gestational hypertension, RR 5.16, 95% CI 2.11-12.6). The RRs for moderate preeclampsia and gestational hypertension were not significantly different from one another (p = 0.18); the RR for severe preeclampsia was significantly different from the RR for moderate preeclampsia and gestational hypertension combined (p = 0.02).CONCLUSIONS: Although 70% of PPCM occurred in women with normotensive pregnancies, HDPs were associated with substantial increases in PPCM risk that depended on HDP severity. The heart's capacity to adapt to a normal pregnancy may be exceeded in some women already susceptible to cardiac insult, contributing to PPCM. HDPs, severe preeclampsia in particular, probably represent an additional cardiac stressor during pregnancy.
KW - Adult
KW - Cardiomyopathies/epidemiology
KW - Denmark
KW - Female
KW - Humans
KW - Hypertension, Pregnancy-Induced/epidemiology
KW - Peripartum Period/physiology
KW - Postpartum Period/physiology
KW - Pre-Eclampsia/epidemiology
KW - Pregnancy
KW - Pregnancy Complications, Cardiovascular/epidemiology
KW - Pregnancy Outcome
KW - Risk Factors
U2 - 10.1371/journal.pone.0211857
DO - 10.1371/journal.pone.0211857
M3 - Journal article
C2 - 30785920
VL - 14
JO - PLoS ONE
JF - PLoS ONE
SN - 1932-6203
IS - 2
M1 - e0211857
ER -
ID: 236614174