Preeclampsia and high blood pressure in early pregnancy as risk factors of severe maternal cardiovascular disease during 50-years of follow-up

Research output: Contribution to journalArticlepeer-review


Objectives: Studies suggest preeclampsia as a risk factor for long term cardiovascular diseases (CVD), while evidence is limited regarding the risk of high blood pressures (BP) in early pregnancy. Study design: A register-based follow-up of 2434 mothers in the Helsingborg Birth Cohort. Associations of high BP in early pregnancy (>95th percentile systolic [SBP], diastolic [BDP], or mean arterial BP [MAP]) during the first antenatal visit and/or preeclampsia with an incident CVD event (ischemic heart disease or stroke) were assessed. To model risks and adjust for co-variables, Cox proportional hazard regression was used. Results: Of the included women, 120 (4.9%) had high SBP, 49 (2%) high DBP, 104 (4.3%) high MAP in early pregnancy; and 115 (4.7%) developed preeclampsia. During 52 years of follow-up, totalling 121,457 person-years, 534 (21.9%) women experienced a CVD event. Women with preeclampsia had a higher risk of developing CVD compared to women without preeclampsia (HR 1.5, 95%CI: 1.1–2.2), while risks among women with high BPs were slightly higher. In adjusted analysis, risk estimates were approximately 50% higher than that of the reference groups for all four studied exposures. Of women with later CVD, 35 (6.6%) had preeclampsia, and another 31 (5,8%) women high SBP or high MAP. Without later preeclampsia, high SBP constituted a significant risk factor (HR 1.6, 95%CI: 1.1–2.4) for CVD. Conclusions: Women with SBP > 95th percentile in early pregnancy, but without later preeclampsia, have a higher risk of developing CVD that is comparable to women with history of preeclampsia.

Original languageEnglish
Pages (from-to)79-85
Number of pages7
JournalPregnancy Hypertension
Early online date2021
Publication statusPublished - 2021 Dec 1

Bibliographical note

Funding Information:
This study was supported by financial grants from the Stig and Ragna Gorthon Foundation, Helsingborg, Sweden, and The Region Skane County Council, Helsingborg Hospital, Department of Research and Education, Sweden, to CI, the principal investigator of the HbgBC. ST is supported by a grant from the Swedish Research Council (2019–02082).

Publisher Copyright:
© 2021 The Author(s)

Copyright 2021 Elsevier B.V., All rights reserved.

Subject classification (UKÄ)

  • Obstetrics, Gynecology and Reproductive Medicine
  • Cardiac and Cardiovascular Systems


  • Blood pressure
  • Cardiovascular disease
  • Cohort studies
  • Maternal exposure
  • Preeclampsia
  • Pregnancy


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