Comparing angiogenic biomarkers and clinical history of hypertensive disease of pregnancy with the association of hypertension up to 15 years after delivery

ObjectiveWe investigated the independent and comparative association of a history of hypertensive disease of pregnancy and elevated serum soluble fms-like tyrosine kinase 1 to placental growth factor (sFlt-1/PlGF) ratio during the second half of pregnancy with the development of HTN up to 15 years after delivery. Study Design: N=1,238 singleton pregnancies were part of a prospective birth cohort study that enrolled patients from 2006-2008. Serum sFlt-1/PlGF was collected at a median of 26.0 and 35.1 weeks gestation. Adjusted Cox proportional hazard models estimated hazard ratios and 95%CI for the time to diagnosis for Stage 1 and Stage 2 HTN within 15 years PP in association with diagnoses of HDP and interquartile range of sFlt-1/PlGF. We adjusted for confounders. ResultsOf the n=993 women, n=260 (29.18%) were diagnosed with stage 1 and n=169 (17.0%) with Stage 2 HTN within 15 years of delivering.A history of PE or a history of gestational hypertension were both significantly associated with developing HTN later in life with adjusted hazard ratios of 2.17 (95% CI, 1.44-3.28) and 3.50 (95% CI, 2.21-5.54). There was no significant association between the hazard of developing HTN and the sFlt/PlGF ratio. However, mean PlGF levels during pregnancy in those who remained normotensive in the follow-up were higher at 546.7 pg/mL (SD= 369.5) compared to 513.7 pg/mL (SD=389.9) in the group with stage 1 and stage 2 HTN combined and 471.7 pg/mL (SD=471.7) in the stage 2 only group (p=0.008 and p=0.001). ConclusionIn patients followed for up to 15 years after delivery, a clinical history of hypertensive disease of pregnancy was significantly associated with the hazard of developing HTN later in life, while elevated sFlt-1/PlGF biomarker levels were not.However, mean PlGF levels in the latter half of pregnancy were significantly lower in those who developed HTN later in life.