Hypertensive disorders in pregnancy and cerebrovascular disease in later life

Hypertension is a major etiological factor in cerebrovascular disease. A number of studies have attempted to determine whether pre-eclampsia during pregnancy is associated with an increased risk of cerebrovascular disease in later life. The cohort study reported by Hannaford reported a non-significant trend toward an increased risk of cerebrovascular disease in relation to a history of pre-eclampsia. However, they did report that women who had no diagnosis of a hypertensive disorder of pregnancy had a lower risk of cere-brovascular disease in later life than nulliparous women (Hannaford et al., 1997). The cohort study of 600,000 women from Denmark found a fivefold risk of stroke among women delivered preterm with a diagnosis of pre-eclampsia but no excess risk of stroke among those who experienced pre-eclampsia but delivered at term (Irgens et al., 2001). These and other authors have shown that preterm birth in the absence of pre-eclampsia is associated with an increased risk of later stroke (Irgens et al., 2001; Pell et al., 2004). The linked Aberdeen data allowed comparison of women with gestational hypertension and those with pre-eclampsia. The association with later cerebro-vascular disease was stronger among the pre-eclampsia group (relative risk 2.1 for hospital admission and 3.5 for death) than among the gestational hypertensive group (relative risk 1.4 for hospital admission and 2.9 for death) and, indeed, was only statistically significant in the former group. These data generally support the interpretation that pre-eclampsia is associated with later cerebrovascular disease. It is unknown, however, whether this association is wholly explained by the association between pre-eclampsia and chronic hypertension.

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