Importance Preterm delivery has been associated with future cardiometabolic disorders in women. However, the long-term risks of chronic hypertension associated with preterm delivery and whether such risks are attributable to familial confounding are unclear. Such knowledge is needed to improve long-term risk assessment, clinical monitoring, and cardiovascular prevention strategies in women.

Objective To examine the long-term risks of chronic hypertension associated with preterm delivery in a large population-based cohort of women.

Design, Setting, and Participants This national cohort study assessed all 2 195 989 women in Sweden with a singleton delivery from January 1, 1973, to December 31, 2015. Data analyses were conducted from March 8, 2021, to August 20, 2021.

Exposures Pregnancy duration identified from nationwide birth records.

Main Outcomes and Measures New-onset chronic hypertension identified from primary care, specialty outpatient, and inpatient diagnoses using administrative data. Cox proportional hazards regression was used to compute hazard ratios (HRs) while adjusting for preeclampsia, other hypertensive disorders of pregnancy, and other maternal factors. Cosibling analyses were assessed for potential confounding by shared familial (genetic and/or environmental) factors.

Results In 46.1 million person-years of follow-up, 351 189 of 2 195 989 women (16.0%) were diagnosed with hypertension (mean [SD] age, 55.4 [9.9] years). Within 10 years after delivery, the adjusted HR for hypertension associated with preterm delivery (gestational age <37 weeks) was 1.67 (95% CI, 1.61-1.74) and when further stratified was 2.23 (95% CI, 1.98-2.52) for extremely preterm (22-27 weeks of gestation), 1.85 (95% CI, 1.74-1.97) for moderately preterm (28-33 weeks of gestation), 1.55 (95% CI, 1.48-1.63) for late preterm (34-36 weeks of gestation), and 1.26 (95% CI, 1.22-1.30) for early-term (37-38 weeks of gestation) compared with full-term (39-41 weeks of gestation) delivery. These risks decreased but remained significantly elevated at 10 to 19 years (preterm vs full-term delivery: adjusted HR, 1.40; 95% CI, 1.36-1.44), 20 to 29 years (preterm vs full-term delivery: adjusted HR, 1.20; 95% CI, 1.18-1.23), and 30 to 43 years (preterm vs full-term delivery: adjusted HR, 95% CI, 1.12; 1.10-1.14) after delivery. These findings were not explained by shared determinants of preterm delivery and hypertension within families.

Conclusions and Relevance In this large national cohort study, preterm delivery was associated with significantly higher future risks of chronic hypertension. These associations remained elevated at least 40 years later and were largely independent of other maternal and shared familial factors. Preterm delivery should be recognized as a lifelong risk factor for hypertension in women.

重要性早产与女性未来的心脏代谢紊乱有关。然而，与早产相关的慢性高血压的长期风险以及这些风险是否可归因于家族混杂因素尚不清楚。需要这些知识来改善女性的长期风险评估、临床监测和心血管预防策略。

目的在大量女性人群中检查与早产相关的慢性高血压的长期风险。

设计、背景和参与者这项全国队列研究评估了 1973 年 1 月 1 日至 2015 年 12 月 31 日期间瑞典所有 2 195 989 名单胎分娩妇女。数据分析于 2021 年 3 月 8 日至 2021 年 8 月 20 日进行。

暴露根据全国出生记录确定的怀孕持续时间。

主要成果和措施使用管理数据从初级保健、专科门诊和住院诊断中识别出新发慢性高血压。 Cox 比例风险回归用于计算风险比 (HR)，同时调整先兆子痫、其他妊娠期高血压疾病和其他母体因素。共同分析通过共同的家族（遗传和/或环境）因素评估潜在的混杂因素。

结果在 4610 万人年的随访中，2 195 989 名女性中的 351 189 名 (16.0%) 被诊断患有高血压（平均 [SD] 年龄，55.4 [9.9] 岁）。产后 10 年内，与早产（胎龄 <37 周）相关的高血压的调整 HR 为 1.67（95% CI，1.61-1.74），进一步分层后，对于极度早产，该 HR 为 2.23（95% CI，1.98-2.52）。早产（妊娠 22-27 周）、中度早产（妊娠 28-33 周）为 1.85（95% CI，1.74-1.97）、晚期早产（34-36 周）为 1.55（95% CI，1.48-1.63）妊娠期），与足月（妊娠 39-41 周）相比，早期（妊娠 37-38 周）分娩为 1.26（95% CI，1.22-1.30）。这些风险在 10 至 19 岁时有所下降，但仍显着升高（早产与足月分娩：调整后 HR，1.40；95% CI，1.36-1.44）、20 至 29 岁（早产与足月分娩：调整后 HR，1.20） ；95% CI，1.18-1.23），以及产后 30 至 43 年（早产与足月分娩：调整后的 HR，95% CI，1.12；1.10-1.14）。这些发现并不能用家庭内早产和高血压的共同决定因素来解释。

结论和相关性在这项大型全国队列研究中，早产与未来慢性高血压的风险显着升高相关。这些关联至少在 40 年后仍然保持较高水平，并且在很大程度上独立于其他母亲和共同的家族因素。早产应被视为女性高血压的终生危险因素。