Pregnancy-Induced Hypertension Tied to Metabolic Syndrome

Even mild pregnancy-induced hypertension (PIH) boosts the risk that a woman will develop metabolic syndrome later on in life. At 7.8-year follow-up, the 168 women with a history of PIH had more than triple the prevalence of metabolic syndrome compared with 168 matched controls without PIH.

, Drs. Jean-Claude Forest and Dr. Yves Giguere of l’Hopital St-Francois d’Assise in Quebec City, said that “the findings suggest that women who develop hypertension for the first time during pregnancy should be followed carefully thereafter, and may also provide clues to the pathophysiology of PIH, preeclampsia and eclampsia, which remain poorly understood.”

"What this study shows is that we should probably change our mode of practice and make sure that these women are informed that they are at increased risk of developing cardiovascular disease later on," Dr. Forest said, adding that their physicians should also institute more frequent measurements of blood pressure, blood glucose, and other relevant tests.

While past research has suggested that PIH may be linked to an increased risk of heart disease later in life, this is the first study to look at the question prospectively.

The 168 case-control pairs were selected from 3799 women who gave birth for the first time between 1989 and 1997.
The women who developed PIH were more likely to have several features of the metabolic syndrome, including obesity and significantly higher diastolic and systolic blood pressures. On average, women who developed PIH had systolic pressures of 115 mm Hg and diastolic blood pressures of 75 mm Hg, compared to 108 mm Hg and 70 mm Hg for women who did not develop the condition during pregnancy.

The PIH subjects also had lower levels of HDL cholesterol (1.30 mmol/L vs. 1.42 mmol/L), higher fasting blood glucose (5.2 vs. 5.0 mmol/L) and higher insulin levels (119 vs. 90 pmol/L).

The prevalence of the metabolic syndrome was 4.9 times higher among the women with PIH, the researchers found, and was 3.6-fold greater after adjustment for confounding factors.

The findings make it clear, Dr. Giguere said, that PIH is not an isolated phenomenon of pregnancy, but instead should be a "flag" to physicians that a woman is at increased risk of future cardiovascular disease. He and his colleagues are currently investigating the genes that may be involved in linking PIH to cardiovascular disease risk.

Obstet Gynecol 2005;105.
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