Cardiovascular risk profile after a complicated pregnancy across ethnic groups: the HELIUS study

Lay Summary Women of different ethnic backgrounds who had pregnancy complications (high blood pressure or diabetes during pregnancy, or who delivered their baby too early) have a higher risk of heart disease later in life. Screening for a high risk of heart disease is important because interventions may help to prevent heart disease. Currently, general practitioners use several criteria to select women for screening, such as heart disease among close relatives or smoking. In our study in women in whom these 'traditional' criteria for screening were measured, the pregnancy complications did not help to find more women with a high risk. Yet, pregnancy complications may be a signal for both patients and healthcare professionals to regularly consider the need for screening.Women who had high blood pressure in pregnancy or delivered their baby too early had up to two times more often chronic hypertension or kidney disease later in life. Women who had diabetes in pregnancy, had up to eight times more type 2 diabetes later in life.Women of South-Asian Surinamese, African Surinamese, and Ghanaian origin living in the Netherlands more often had pregnancy complications and cardiovascular risk factors than women with a Dutch background. Aims Little is known about how pregnancy complications and cardiovascular disease (CVD) risk are associated, specifically among ethnic minorities. In this study, we examined this association in women from six ethnic groups, and the potential value of pregnancy complications as eligibility criterion for CVD risk screening. Methods and results We conducted a cross-sectional study combining obstetric history from the Dutch perinatal registry with data on cardiovascular risk up to 15 years after pregnancy from the multi-ethnic HELIUS study. We included 2466 parous women of Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish, and Moroccan origin. Associations were studied across ethnicities and predictive value of pregnancy complications for CVD risk factors above traditional eligibility criteria for CVD risk screening was assessed using Poisson regression. History of hypertensive disorders of pregnancy and preterm birth were associated with higher prevalence of chronic hypertension and chronic kidney disease across most groups [prevalence ratio (PR): 1.6-1.9]. Gestational diabetes mellitus was associated with increased type 2 diabetes mellitus risk, particularly in ethnic minority groups (PR: 4.5-7.7). Associations did not significantly differ across ethnic groups. The prediction models did not improve substantially after adding pregnancy complications to traditional eligibility criteria for CVD risk screening. Conclusion History of hypertensive disorders of pregnancy, preterm birth, and gestational diabetes mellitus is associated with CVD risk factors in parous women, without evidence of a differential association across ethnic groups. However, addition of pregnancy complications to traditional eligibility criteria for CVD risk screening does not substantially improve the prediction of prevalent CVD risk factors.