Objective To investigate whether severe and recurrent pre-eclampsia increase the risk for long-term maternal atherosclerotic disease. Study design A population-based study compared the incidence of long-term atherosclerotic morbidity in a cohort of women who delivered in the years 1988–2012. The exposure variable was pre-eclampsia. Mean follow-up duration was 11.2 years. Kaplan–Meier survival curves were used to estimate cumulative incidence of simple, complex (ie, angina pectoris and congestive heart failure, respectively) cardiovascular-related and renal-related hospitalisations. Cox proportional hazards models were used to estimate the adjusted HRs for cardiovascular and renal morbidity. Results During the study, 96 370 patients met the inclusion criteria; 7824 (8.1%) in patients who were diagnosed at least once with pre-eclampsia. Patients with pre-eclampsia had higher rates of cardiovascular morbidity including cardiac non-invasive (OR 1.4; 95% CI 1.1 to 1.7; p=0.005) and invasive diagnostic procedures (OR 1.7; 95% CI 1.2 to 2.3; p=0.001), simple (OR 1.5; 95% CI 1.2 to 1.8; p=0.001), as well as complex cardiovascular events (OR 2.4; 95% CI 2.2 to 2.8; p=0.001) and renal (OR 3.7; 95% CI 2.2 to 6.0; p=0.001) hospitalisations. A significant linear association was noted between the severity of pre-eclampsia (no pre-eclampsia, mild pre-eclampsia, severe pre-eclampsia and eclampsia) and cardiovascular (2.7% vs 4.5% vs 5.2% vs 5.7%, respectively; p=0.001), as well as renal disease (0.1% vs 0.2% vs 0.5% vs 1.1%, respectively; p=0.001). Likewise, a linear association was found between the number of previous pregnancies with pre-eclampsia (no pre-eclampsia, one event and ≥2 events of pre-eclampsia) and risk for future simple cardiovascular disease (1.2% vs 1.6% vs 2.2%, respectively; p=0.001), complex cardiovascular disease (1.3% vs 2.7% vs 4.6%, respectively; p=0.001) and total cardiovascular hospitalisations (2.7% vs 4.4% vs 6.0%, respectively; p=0.001). Using a Kaplan–Meier survival curve, patients with pre-eclampsia had significantly higher cumulative incidence of atherosclerotic-related hospitalisations. In a Cox proportional hazards model, adjusted for confounders such as maternal age, parity, diabetes mellitus and obesity, pre-eclampsia remained independently associated with atherosclerotic hospitalisations. Conclusions Previous pregnancy with pre-eclampsia is an independent risk factor for long-term maternal atherosclerotic morbidity. The risk is more substantial for patients with severe and recurrent episodes of pre-eclampsia.

Gestational diabetes mellitus (GDM) was found to be an independent risk factor for recurrent long-term type 2 diabetes mellitus, cardiovascular morbidity, and vascular endothelial dysfunction. However, data on the link between GDM and future risk for long-term maternal renal disease are limited. The purpose of this study was to investigate whether GDM poses a risk for subsequent long-term maternal renal morbidity. A population-based noninterventional study compared the incidence of future renal morbidity in a cohort of women with and without previous GDM. Deliveries occurred during a 25-year period, with a mean follow-up duration of 11.2 years. The study was conducted at the Soroka University Medical Center. The study population was composed of all singleton pregnancies in women who delivered between January 1988 and December 2013. The main outcome was diagnosis of renal morbidities. Of 97,968 women who met the inclusion criteria, 9542 (9.7%) had at least 1 previous pregnancy with GDM. Using a Kaplan-Meier survival curve, we show that women with GDM had higher rates of total renal morbidity (0.1% vs 0.2%, for no GDM and with GDM, respectively; odds ratio, 2.3, 95% confidence interval, 1.4-3.7; P < .001). In addition, we found a significant dose-response association (using the χ(2) test for trends) between the number of pregnancies with GDM and future risk for renal morbidity (0.1%, 0.2%, and 0.4% for no GDM, 1 episode of GDM, and 2 episodes of GDM, respectively; P < .001). In a Cox proportional hazards model, adjusted for confounders, GDM was independently associated with future renal morbidity. GDM is a significant risk factor for future maternal renal morbidity. The risk is more substantial for patients with recurrent episodes of GDM.