Five year recall study of Sri Lnkan women with previous pregnancy induced hypertension

Abstract

BACKGROUND: Pregnancy induced hypertension (PIH) has been associated with long term cardiovascular morbidity in western societies. OBJECTIVE: To determine any long term cardiovascular complications among Sri Lankan women managed five years previously for pregnancy induced hypertension. METHOD: Cross sectional observational case control recall study. Eighty seven women managed for pregnancy induced hypertension five years previously in a single unit (excluding those with chronic hypertension during index pregnancy); and 68 age matched controls at five years post partum from the same unit, were studied using identical recall methods. OUTCOME MEASURES: Current cardiovascular risks (CV) (hypertension, type 2 diabetes mellitus, and hyperlipidaemia; anthropometry, resting blood pressure; fasting blood sugar, lipids); Metabolic Syndrome (MS) and polycystic ovaries (PCO). RESULTS: PIH- (n = 87): PIH occurred in 45 primigravida (P), 42 multigravida (M) with impending eclampsia in 30 (P19, M 11) and eclampsia in 3 (P 2, M 1); Recurrent PIH in 27 (31 percent) with 5 impending eclampsia. Current age 39.36.3; BMI >25 kg/m2 in 30 (34.4 percent), waist circumference > 80.9cm (95th CI of controls) in 49 (56.3 percent) CV risks: Hypertension- 36 previously diagnosed and 12 others identified (JNC 7 criteria), total 48/87 (55 percent); Diabetes mellitus/IGT - 7 previously diagnosed and another 35 had impaired fasting glucose (IFG -WHO criteria), total 42/87 (48 percent); triglycerides > 150mg/dl in 13; HDL <50mg/dl in 50; 1 had ischaemic heart disease; 20(22 percent) had polycystic ovaries. Prevalence of having more than 2 CV risk factors 40.2 percent (35/87) : Only 41/87 (47.1 percent) patients had been followed up for cardiovascular complications. Controls- (n = 68); current age 32.15.1; BMI > 25 kg/m2 in 11 (16.1 percent), waist circumference >80.9 in 27(39.7 percent). CV risks: Hypertension- 7 previously diagnosed and 5 others identified, total 12/68 (17 percent); Diabetes mellitus/IGT 8 previously diagnosed and another 10 had IFG, total 18/68 (26 percent); triglycerides > 150mg/dl in 5; HDL<50mg/dl in 40; 7 (10 percent) had polycystic ovaries. " Prevalence of having 1 or more CV risk factors 17.6 percent (12/68) PIH vs. Controls: Cumulative prevalence of MS 42.5 percent vs. 11.7 percent (p 0.0000) Prevalence of PCO 22.9 percent vs 10.2 percent (p 0.01) Prevalence of having one or more CV risk factors 40.2 percent vs. 17.6 percent (p =0.0005) CONCLUSION: Sri Lankan women with previous PIH have a higher risk of developing long term cardiovascular complications and the Metabolic Syndrome, when compared to controls. A field follow up study would exclude possible selection bias and help assess the need for post partum long term follow up of women with PIH.