Adverse pregnancy outcomes, longitudinal change in eGFR, and incident hypertension in women: a population-based cohort study

Background As the traditional risk factors cannot account for all hypertension (HTN) incidents, it is of great importance to determine other risk factors. This study aimed to identify long-term HTN risk associated with annual change of estimated glomerular filtration rate (eGFR) and prior adverse pregnancy outcomes (APOs) among women participating in a population-based study of Tehran Lipid and Glucose Study (TLGS).Methods This study was performed using prospectively ascertained data of TLGS. A total of 2,404 women with recorded data of eGFR measurements and APO status participated. Data collection was conducted according to the standard guide of TLGS. Cox proportional-hazards regression models were used to estimate the hazard ratios (HRs) and their 95% confidence intervals (CIs) for the incidence of HTN.Results A total of 2,404 women were enrolled. Adjusted model shows that, a one z-score positive eGFR change was associated with a reduced risk of developing HTN among women with a history of APOs (HR= 0.816, 95% CI: 0.708–0.939, p = 0.005). In contrast, no significant association was observed among women without a history of APOs (HR= 1.027, 95% CI: 0.913–1.156, p = 0.645). We also observed a statistically significant interaction between APO status and annual eGFR change for HTN incidence in total population (interaction p = 0.02).Conclusion The history of APOs is accompanied by alterations in kidney function in the long term. In women with a history of APOs, a positive change in eGFR levels was independently associated with a lower risk of HTN.