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Recurrent pre-eclampsia and subsequent cardiovascular risk
  1. Nathalie Auger1,2,
  2. William D Fraser3,
  3. Mireille Schnitzer4,
  4. Line Leduc5,
  5. Jessica Healy-Profitós1,2,
  6. Gilles Paradis1,6
  1. 1Institut national de santé publique du Québec, Montreal, Québec, Canada
  2. 2University of Montreal Hospital Research Centre, Montreal, Québec, Canada
  3. 3Department of Obstetrics and Gynecology, CRCHUS, University of Sherbrooke, Sherbrooke, Québec, Canada
  4. 4Faculty of Pharmacy, University of Montreal, Montreal, Québec, Canada
  5. 5Department of Obstetrics and Gynecology, Sainte-Justine Hospital Research Centre, University of Montreal, Montreal, Québec, Canada
  6. 6Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Québec, Canada
  1. Correspondence to Dr Nathalie Auger, 190 Cremazie Blvd E, Montreal, Québec, Canada H2P 1E2; nathalie.auger{at}


Objective To determine the association between recurrent pre-eclampsia and long-term cardiovascular hospitalisation.

Methods This study identified cardiovascular hospitalisations up to 25 years after pregnancy for all women who delivered between 1989 and 2013 in Québec, Canada. Exposures included recurrent and non-recurrent pre-eclampsia in women with two deliveries or more (N=606 820), and pre-eclampsia in women with only one delivery (N=501 761). Incidence, timing and risk of cardiovascular complications were calculated using accelerated failure time models adjusted for age, pre-existing disease, socioeconomic deprivation and period. Outcomes included a range of cardiovascular hospitalisations and procedures.

Results Women with recurrent pre-eclampsia had higher incidence of cardiovascular hospitalisation (281.4 per 1000) than women with non-recurrent (167.7 per 1000) or no pre-eclampsia (72.6 per 1000). Mean time to cardiovascular hospitalisation was 10.5 years for recurrent, 11.6 years for non-recurrent and 12.7 years for no pre-eclampsia, a difference of 17.3% for recurrent and 8.7% for non-recurrent relative to no pre-eclampsia. Compared with no pre-eclampsia, recurrent pre-eclampsia was associated with 2 times the risk of heart disease (95% CI 1.69 to 2.29) and 3 times the risk of cerebrovascular disease (95% CI 2.25 to 4.05). Pre-eclampsia in women with one delivery was associated with 3 times greater risk of cardiovascular hospitalisation compared with no pre-eclampsia in women with two deliveries or more (95% CI 2.96 to 3.25).

Conclusions Recurrent pre-eclampsia is associated with higher risk of future cardiovascular hospitalisation compared with no pre-eclampsia, and significantly shorter time to first cardiovascular event. Cardiovascular screening should be performed earlier for women with recurrent pre-eclampsia.

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  • Contributors NA conceived and designed the study with JH-P. JH-P analysed the data under guidance of NA. MS provided statistical expertise. WDF, LL and GP helped interpret the results. NA drafted the manuscript with JH-P, and all authors revised the article for important intellectual content. All authors approved the final version. NA is guarantor.

  • Funding This study was funded by the Canadian Institutes of Health Research (MOP-130452). NA received a career award from the Fonds de recherche du Québec-Santé (grant 25128).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.