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Hypertensive disorders of pregnancy (HDP) have been associated with heart failure (HF). It is unknown whether concurrent pregnancy complications (small-for-gestational-age or preterm delivery) or recurrent HDP modify HDP-associated HF risk. In this cohort study, we included Norwegian women with a first birth between 1980 and 2004. Follow-up occurred through 2009. Cox models examined gestational hypertension and preeclampsia in the first pregnancy as predictors of a composite of HF-related hospitalization or HF-related death, with assessment of effect modification by concurrent small-for-gestational-age or preterm delivery. Additional models were stratified by final parity (1 versus ≥2 births) and tested associations with recurrent HDP. Among 508 422 women, 565 experienced incident HF over a median 11.8 years of follow-up. After multivariable adjustment, gestational hypertension in the first birth was not significantly associated with HF (hazard ratio, 1.41 [95% CI, 0.84-2.35], P=0.19), whereas preeclampsia was associated with a hazard ratio of 2.00 (95% CI, 1.50-2.68, P<0.001). Among women with HDP, risks were not modified by concurrent small-for-gestational-age or preterm delivery (Pinteraction=0.42). Largest hazards of HF were observed in women whose only lifetime birth was complicated by preeclampsia and women with recurrent preeclampsia. HF risks were similar after excluding women with coronary artery disease. In summary, women with preeclampsia, especially those with one lifetime birth and those with recurrent preeclampsia, experienced increased HF risk compared to women without HDP. Further research is needed to clarify causal mechanisms. [ABSTRACT FROM AUTHOR]

Plant-based diets have been associated with a lower risk of cardiovascular disease in nonpregnant adults, but specific evidence for their effects on risk of hypertensive disorders of pregnancy is scarce. This study aimed to evaluate the prospective association between adherence to plant-based diets before pregnancy and the risk for hypertensive disorders of pregnancy. We hypothesized that women with higher adherence to plant-based diets would have a lower risk for hypertensive disorders of pregnancy. We followed 11,459 parous women (16,780 singleton pregnancies) without chronic diseases, a history of preeclampsia, and cancers who participated in the Nurses' Health Study II (1991–2009), which was a prospective cohort study. Diet was assessed every 4 years using a validated food frequency questionnaire from which we calculated the plant-based diet index (higher score indicates higher adherence) to evaluate the health associations of plant-based diets among participants while accounting for the quality of plant-based foods. Participants self-reported hypertensive disorders of pregnancy, including preeclampsia and gestational hypertension. We estimated the relative risk of hypertensive disorders of pregnancy in relation to plant-based diet index adherence in quintiles using generalized estimating equations log-binomial regression while adjusting for potential confounders and accounting for repeated pregnancies for the same woman. The mean (standard deviation) age at first in-study pregnancy was 35 (4) years. A total of 1033 cases of hypertensive disorders of pregnancy, including 482 cases of preeclampsia (2.9%) and 551 cases of gestational hypertension (3.3%) were reported. Women in the highest quintile of plant-based diet index were significantly associated with a lower risk for hypertensive disorders of pregnancy than women in the lowest quintile (relative risk, 0.76; 95% confidence interval, 0.62–0.93). There was an inverse dose-response relationship between plant-based diet index and risk for hypertensive disorders of pregnancy. The multivariable-adjusted relative risk (95% confidence interval) of hypertensive disorders of pregnancy for women in increasing quintiles of plant-based diet index were 1 (ref), 0.93 (0.78–1.12), 0.86 (0.72–1.03), 0.84 (0.69–1.03), and 0.76 (0.62–0.93) with a significant linear trend across quintiles (P trend=.005). This association was slightly stronger for gestational hypertension (relative risk, 0.77; 95% confidence interval, 0.60–0.99) than for preeclampsia (relative risk, 0.80; 95% confidence interval, 0.61–1.04). Mediation analysis suggested that body mass index evaluation for dietary assessment and pregnancy explained 39% (95% confidence interval, 15%–70%]) of the relation between plant-based diet index and hypertensive disorders of pregnancy and 48% (95% confidence interval, 12%–86%]) of the relation between plant-based diet index and gestational hypertension. Higher adherence to plant-based diets was associated with a lower risk of developing hypertensive disorders of pregnancy. Much of the benefit seems to be related to improved weight control. [ABSTRACT FROM AUTHOR]

Women with a history of preeclampsia have double the risk of future heart disease and stroke, and elevated risks of hypertension and diabetes. The American Heart Association (AHA) and the American College of Obstetrics and Gynecology now include preeclampsia as a risk factor for future cardiovascular disease (CVD) with the recommendation of obtaining a history of preeclampsia and improving lifestyle behaviors for women with such a history. Research has progressed from asking whether preeclampsia is associated with CVD to how preeclampsia is associated with CVD, and the implications for prevention of CVD among women with a history of preeclampsia. A history of preeclampsia “unmasks” future CVD risk; research is inconclusive whether it also causes vascular damage that leads to CVD. For women with prior preeclampsia, the AHA recommends CVD risk reduction actions similar to those for other “at risk” groups: cessation of cigarette smoking, physical activity, weight reduction if overweight or obese and counseling to follow a “DASH” like diet. The efficacy of these lifestyle modifications to lower risk of CVD in women with prior preeclampsia remains to be determined. Barriers exist to implementing lifestyle improvement measures in this population, including lack of awareness of both patients and clinicians of this link between preeclampsia and CVD. We review patient, provider, and systems level barriers and solutions to leverage this information to prevent CVD among women with a history of preeclampsia. [ABSTRACT FROM AUTHOR]

The article looks at the connection of parental smoking during pregnancy and its impact on adult-onset high blood pressure. A study was performed on information extracted from the 33,086 respondents of the Nurses' Health Study II and the Nurses' Mothers' Cohort, where connections of parental smoking to high blood pressure was evaluated. Results showed that body weight was the factor in proving parental smoking during pregnancy as the cause of hypertension.