Use of family history of cardiovascular disease or chronic hypertension to better identify who needs postpartum cardiovascular risk screening

Published:January 11, 2023DOI:


      Individuals with pregnancies complicated by hypertensive disorders of pregnancy are at increased risk of cardiovascular disease. However, not all who have hypertensive disorders of pregnancy are at risk, and not all who have uncomplicated pregnancies are without risk.


      This study aimed to determine if use of first-degree family history of cardiovascular disease or chronic hypertension better identifies individuals who need postpartum cardiovascular risk screening.


      Participants were included if they had pregnancies complicated by hypertensive disorders of pregnancy or uncomplicated, term pregnancies. Individuals with a first-degree relative with chronic hypertension, myocardial infarction, or stroke were deemed to have a positive family history and were thus included.


      Four groups were considered: 302 individuals with hypertensive disorders of pregnancy who had a positive family history, 218 individuals with hypertensive disorders of pregnancy with no family history, 39 control individuals with a positive family history, and 63 control individuals with no family history. Among individuals with hypertensive disorders of pregnancy, those with a positive family history were more likely to be diagnosed with chronic hypertension, and to have elevated 30-year lipid, 30-year body mass index, and lifetime cardiovascular disease risk score (all P<.05). Among individuals with uncomplicated pregnancies, those with a positive family history were more likely to be diagnosed with chronic hypertension (P<.05) and meet criteria for metabolic syndrome (P<.05).


      First-degree family history of cardiovascular disease and/or chronic hypertension can be used to reliably identify individuals without pregnancy complications who should have postpartum cardiovascular risk screening, and may better determine which individuals who have a pregnancy complicated by hypertensive disorders of pregnancy would most benefit from postpartum cardiovascular risk screening.

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        • Heron M.
        Deaths: leading causes for 2017.
        Natl Vital Stat Rep. 2019; 68: 1-77
        • Smith GN
        • Louis JM
        • Saade GR.
        Pregnancy and the postpartum period as an opportunity for cardiovascular risk identification and management.
        Obstet Gynecol. 2019; 134: 851-862
        • Grandi SM
        • Filion KB
        • Yoon S
        • et al.
        Cardiovascular disease-related morbidity and mortality in women with a history of pregnancy complications.
        Circulation. 2019; 139: 1069-1079
        • Cusimano MC
        • Pudwell J
        • Roddy M
        • Cho CK
        • Smith GN.
        The maternal health clinic: an initiative for cardiovascular risk identification in women with pregnancy-related complications.
        Am J Obstet Gynecol. 2014; 210 (438.e1–9)
        • Smith GN
        • Pudwell J
        • Walker M
        • Wen SW.
        Risk estimation of metabolic syndrome at one and three years after a pregnancy complicated by preeclampsia.
        J Obstet Gynaecol Can. 2012; 34: 836-841
        • Smith GN
        • Pudwell J
        • Saade GR.
        Impact of the new American hypertension guidelines on the prevalence of postpartum hypertension.
        Am J Perinatol. 2019; 36: 440-442
        • Smith GN
        • Walker MC
        • Liu A
        • et al.
        A history of preeclampsia identifies women who have underlying cardiovascular risk factors.
        Am J Obstet Gynecol. 2009; 200 (58.e1–8)
        • Patel J
        • Al Rifai M
        • Scheuner MT
        • et al.
        Basic vs More complex definitions of family history in the prediction of coronary heart disease: the multi-ethnic study of atherosclerosis.
        Mayo Clin Proc. 2018; 93: 1213-1223
        • Kay VR
        • Wedel N
        • Smith GN.
        Family history of hypertension, cardiovascular disease, or diabetes and risk of developing preeclampsia: a systematic review.
        J Obstet Gynaecol Can. 2021; 43 (227–36.e19)
        • Cho GJ
        • Kim HY
        • Park JH
        • et al.
        Prepregnancy factors are associated with development of hypertension later in life in women with pre-eclampsia.
        J Womens Health (Larchmt). 2019; 28: 984-989
        • Ackerman-Banks CM
        • Grechukhina O
        • Spatz E
        • et al.
        Seizing the window of opportunity within 1 year postpartum: early cardiovascular screening.
        J Am Heart Assoc. 2022; 11e024443
        • Smith GN
        • Pudwell J
        • Roddy M.
        The Maternal Health Clinic: a new window of opportunity for early heart disease risk screening and intervention for women with pregnancy complications.
        J Obstet Gynaecol Can. 2013; 35: 831-839
      1. ACOG Practice Bulletin No. 202: Gestational hypertension and preeclampsia.
        Obstet Gynecol. 2019; 133: 1
        • Whelton PK
        • Carey RM
        • Aronow WS
        • et al.
        2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice guidelines.
        Hypertension. 2018; 71: e13-115
        • Alberti KGMM
        • Zimmet P
        • Shaw J
        IDF Epidemiology Task Force Consensus Group. The metabolic syndrome–a new worldwide definition.
        Lancet. 2005; 366: 1059-1062
        • Lloyd-Jones DM
        • Leip EP
        • Larson MG
        • et al.
        Prediction of lifetime risk for cardiovascular disease by risk factor burden at 50 years of age.
        Circulation. 2006; 113: 791-798
        • Pencina MJ
        • D'Agostino RB
        • Larson MG
        • Massaro JM
        • Vasan RS
        Predicting the 30-year risk of cardiovascular disease: the Framingham Heart Study.
        Circulation. 2009; 119: 3078-3084
        • Mosca L
        • Benjamin EJ
        • Berra K
        • et al.
        Effectiveness-based guidelines for the prevention of cardiovascular disease in women–2011 update: a guideline from the American Heart Association.
        J Am Coll Cardiol. 2011; 57: 1404-1423
      2. American College of Obstetricians and Gynecologists' Presidential Task Force on Pregnancy and Heart Disease and Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 212: pregnancy and heart disease.
        Obstet Gynecol. 2019; 133: e320-e356
        • Brown HL
        • Warner JJ
        • Gianos E
        • et al.
        Promoting risk identification and reduction of cardiovascular disease in women through collaboration with obstetricians and gynecologists: a presidential advisory from the American Heart Association and the American College of Obstetricians and Gynecologists.
        Circulation. 2018; 137: e843-e852
        • Goel A
        • Maski MR
        • Bajracharya S
        • et al.
        Epidemiology and mechanisms of de novo and persistent hypertension in the postpartum period.
        Circulation. 2015; 132: 1726-1733
        • Khoury MJ
        • Flanders WD.
        Bias in using family history as a risk factor in case-control studies of disease.
        Epidemiology. 1995; 6: 511-519
        • Bittencourt MS.
        Family history of cardiovascular disease: how detailed should it be?.
        Mayo Clin Proc. 2018; 93: 1167-1168