Supplemental Digital Content is available in the text. Hypertensive disorders of pregnancy (HDP) have been associated with heart failure (HF). It is unknown whether concurrent pregnancy complications (small-for-gestational-age or preterm delivery) or recurrent HDP modify HDP-associated HF risk. In this cohort study, we included Norwegian women with a first birth between 1980 and 2004. Follow-up occurred through 2009. Cox models examined gestational hypertension and preeclampsia in the first pregnancy as predictors of a composite of HF-related hospitalization or HF-related death, with assessment of effect modification by concurrent small-for-gestational-age or preterm delivery. Additional models were stratified by final parity (1 versus ≥2 births) and tested associations with recurrent HDP. Among 508 422 women, 565 experienced incident HF over a median 11.8 years of follow-up. After multivariable adjustment, gestational hypertension in the first birth was not significantly associated with HF (hazard ratio, 1.41 [95% CI, 0.84–2.35], P=0.19), whereas preeclampsia was associated with a hazard ratio of 2.00 (95% CI, 1.50–2.68, P<0.001). Among women with HDP, risks were not modified by concurrent small-for-gestational-age or preterm delivery (Pinteraction=0.42). Largest hazards of HF were observed in women whose only lifetime birth was complicated by preeclampsia and women with recurrent preeclampsia. HF risks were similar after excluding women with coronary artery disease. In summary, women with preeclampsia, especially those with one lifetime birth and those with recurrent preeclampsia, experienced increased HF risk compared to women without HDP. Further research is needed to clarify causal mechanisms.

中文翻译：

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妊娠期高血压疾病女性的心力衰竭

补充数字内容在文本中可用。妊娠期高血压疾病 (HDP) 与心力衰竭 (HF) 相关。尚不清楚并发妊娠并发症（小于胎龄或早产）或复发性 HDP 是否会改变 HDP 相关的 HF 风险。在这项队列研究中，我们纳入了 1980 年至 2004 年间第一次生育的挪威妇女。随访一直持续到 2009 年。Cox 模型检查了第一次怀孕时的妊娠高血压和先兆子痫，作为 HF 相关住院或 HF 相关住院的复合预测因子死亡，同时评估小于胎龄儿或早产的影响。其他模型按最终胎次（1 次与 ≥ 2 次分娩）进行分层，并测试与复发性 HDP 的关联。在 508 422 名女性中，565 人在中位 11.8 年的随访中经历了 HF。多变量调整后，第一胎妊娠高血压与 HF 无显着相关性（风险比，1.41 [95% CI，0.84-2.35]，P=0.19），而先兆子痫与 2.00 的风险比（95% CI）相关, 1.50–2.68, P<0.001)。在患有 HDP 的女性中，风险并未因同时发生的小于胎龄或早产而改变（Pinteraction=0.42）。HF 的最大危害发生在一生中唯一患有先兆子痫的妇女和复发性先兆子痫的妇女中。排除患有冠状动脉疾病的女性后，HF 风险相似。总之，与没有 HDP 的女性相比，患有先兆子痫的女性，尤其是那些终生生育的女性和复发性先兆子痫的女性，经历了更高的 HF 风险。