No link between severe nausea in pregnancy and future cardiovascular disease

Stine Fossum has found no clear evidence of increased cardiovascular risk following hyperemesis gravidarum.


MAIN RESULTS:

  1. Women with a history of hyperemesis gravidarum do not have more risk factors for cardiovascular disease.
  2. Women with hyperemesis gravidarum are not at increased risk of a future cardiovascular event.
  3. Women exposed to hyperemesis gravidarum do not die more often from cardiovascular disease.

THESIS DEFENCE:

Thesis: Long-term cardiovascular risk in women with a history of hyperemesis gravidarum
Candidate: Stine Fossum
Time: November 25, 2019 at 13:15
Place: Oslo University Hospital, Rikshospitalet: Blått auditorium
Link to university website


SUMMARY:

(1/2/3) Extreme nausea and vomiting in early pregnancy is neither associated with higher cardiovascular risk factor burden at mid-life, higher risk of a future cardiovascular event, nor higher risk of dying from any cause. Fossum’s studies include one million births registered in the Medical Birth Registry of Norway between 1967 and 2002.

(2) Data on cardiovascular risk factors was collected from nearly 180,000 40-42-year-old mothers who participated in the Age 40 program. Apart from less physical activity, less smoking and clinically irrelevant lower systolic blood pressure and higher body mass index, the 2140 women who had experienced hyperemesis gravidarum had similar cardiovascular risk profile as those who had not. On the other hand, hypertensive disorders during pregnancy were assosiated with significantly higher levels of blood pressure, body mass index, blood lipids and self-reported diabetes at mid-life.

(3) Data on cardiovascular events was gathered from the Cardiovascular Disease in Norway (CVDNOR) project. More than 43,000 women had an event between 1994 and 2009. The combined endpoint of cardiovascular death, stroke, myocardial infarction or angina hospitalisation was not influenced by previous hyperemesis gravidarum. However, women with hyperemesis gravidarum had a 28 % higher risk of hospitalisation due to angina pectoris.

(1) Fossum used the Norwegian Cause of Death Registry to evaluate the association between hyperemesis gravidarum and all-cause and cause-specific death. More than 43,000 women died during the median follow-up period of 26 years. In the crude analysis, the risk was 18 % lower among women with previous hyperemesis gravidarum, but after adjustment for confounders this association was no longer statistically significant. Hyperemesis gravidarum was not associated with cardiovascular death. However, risk of cancer death was 14 % lower among women with previous hyperemesis gravidarum.


REFERENCES:

(1) Fossum, S., Vikanes, Å. V., Næss, Ø., Vos, L., Grotmol, T., & Halvorsen, S. (2017). Hyperemesis gravidarum and long‐term mortality: a population‐based cohort studyBJOG: An International Journal of Obstetrics & Gynaecology124(7), 1080-1087.

(2) Fossum, S., Halvorsen, S., Vikanes, Å. V., Roseboom, T. J., Ariansen, I., & Næss, Ø. (2018). Cardiovascular risk profile at the age of 40–45 in women with previous hyperemesis gravidarum or hypertensive disorders in pregnancy: A population-based studyPregnancy hypertension12, 129-135

(3) Fossum, S., Næss, Ø., Halvorsen, S., Tell, G. S., & Vikanes, Å. V. (2019). Long-term cardiovascular morbidity following hyperemesis gravidarum: A Norwegian nationwide cohort studyPloS one14(6), e0218051.