ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Hypertension
Subtypes and onset of hypertensive disorders of pregnancy and cardiovascular disease within 5 years after delivery
Hui Hu 1
David A. Savitz 2
Elizabeth Shenkman 3
1. Brigham and Women's Hospital, Harvard Medical School, Boston, United States
2. Brown University School of Public Health, Providence, United States
3. University of Florida Department of Health Outcomes & Biomedical Informatics, Gainesville, United States
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Abstract
Background: Hypertensive disorders of pregnancy (HDP) are established predictors of long-term cardiovascular disease (CVD), but the short-term postpartum CVD risk by HDP subtype and onset remains unclear. Materials and methods: We linked electronic health records with vital statistics for 755,606 singleton deliveries in Florida (2012–2017) to examine how different subtypes and onset of HDP are associated with CVD within 5 years postpartum. We classified HDP into six subtypes - chronic hypertension, gestational hypertension, mild preeclampsia, severe preeclampsia, eclampsia, and superimposed preeclampsia - and defined onset as early (<34 weeks) or late (≥34 weeks). Seven CVD outcomes (heart failure, ischemic heart disease, cerebrovascular disease/stroke, arrhythmia/cardiac arrest, cardiomyopathy, peripheral vascular disease, and new-onset chronic hypertension) within five years postpartum were identified. Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) after adjusting for sociodemographic and clinical covariates. Results: Compared with normotensive pregnancies, superimposed preeclampsia carried the highest risks for stroke (HR 3.39; 95% CI 2.93–3.92), arrhythmia (2.62; 2.25–3.07), and peripheral vascular disease (3.09; 2.67–3.57). Eclampsia showed the strongest associations with heart failure (5.23; 3.70–7.39), ischemic heart disease (3.61; 2.65–4.92), and cardiomyopathy (5.25; 3.37–8.18). Severe preeclampsia was most strongly associated with new hypertension (3.27; 3.10–3.46). Early-onset eclampsia and superimposed preeclampsia showed higher CVD risks than their late-onset counterparts, whereas late-onset gestational hypertension and mild preeclampsia were more strongly associated with new hypertension and cardiomyopathy, respectively.
Summary
Keywords
arrhythmia, Cardiac arrest, cardiomyopathy, Cardiovascular Diseases, cerebrovascular disease, Eclampsia, Gestational hypertension, Heart Failure
Received
22 September 2025
Accepted
02 February 2026
Copyright
© 2026 Hu, Savitz and Shenkman. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Hui Hu
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