Long-term cardiovascular morbidity following hyperemesis gravidarum: A Norwegian nationwide cohort study

by Stine Fossum, Øyvind Næss, Sigrun Halvorsen, Grethe S. Tell, Åse V. Vikanes

Objective

To investigate whether exposure to hyperemesis gravidarum (hyperemesis) is associated with subsequent maternal cardiovascular morbidity.

Design

Nationwide cohort study.

Setting

Medical Birth Registry of Norway (1967–2002) linked to the nationwide Cardiovascular Disease in Norway project 1994–2009 (CVDNOR) and the Cause of Death Registry.

Population

Women in Norway with singleton births from 1967 to 2002, with and without hyperemesis, were followed up with respect to cardiovascular outcomes from 1994 to 2009.

Methods

Cox proportional hazards regression model was applied to estimate hazard ratios (HRs) with 95% confidence interval (CI).

Main outcome measures

The first hospitalisation due to nonfatal stroke, myocardial infarction or angina pectoris, or cardiovascular death.

Results

Among 989 473 women with singleton births, 13 212 (1.3%) suffered from hyperemesis. During follow-up, a total of 43 482 (4.4%) women experienced a cardiovascular event. No association was found between hyperemesis and the risk of a fatal or nonfatal cardiovascular event (adjusted HR 1.08; 95% CI 0.99–1.18). Women with hyperemesis had higher risk of hospitalisation due to angina pectoris (adjusted HR 1.28; 95% CI 1.15–1.44). The risk of cardiovascular death was lower among hyperemetic women in age-adjusted analysis (HR 0.73; 95% CI 0.59–0.91), but the association was no longer significant when adjusting for possible confounders.

Conclusion

Women with a history of hyperemesis did not have increased risk of a cardiovascular event (nonfatal myocardial infarction or stroke, angina pectoris or cardiovascular death) compared to women without.