Long-term outcomes of hypertensive disorders of pregnancy: a secondary data analysis of Million Women Study, UK

Background

Hypertensive disorders of pregnancy (HDP) include gestational hypertension, defined as new onset of hypertension after 20 weeks of gestation, and its spectrum of complications, pre-eclampsia and eclampsia. HDP is not only the most common cause of maternal morbidity and mortality globally, it is also a risk factor for future cardiovascular disease (CVD), with some arguing that its negative effect on women’s longer term cardiovascular health is stronger than smoking. A direct biological link between HDP and heart failure has been proposed with varying degrees of effect on cardiac myocytes across the severity spectrum: mild hypertension/ pre-eclampsia/ eclampsia. Considering the number of pregnancies each year and the incidence of HDP, we estimate that by the target year of the Sustainable Development Goals (2030), more than 126 million women will develop HDP and will need screening to prevent future cardiovascular complications and death. Therefore, it is important to understand the sociodemographic, lifestyle and clinical factors that could increase or decrease the risk of future CVD in women who had HDP. This could facilitate the development of a risk prediction model to identify women with a higher risk, as well as inform interventions to lower the risk of future CVD. A study using data from the Million Women Study in the UK showed that HDP was associated with an increased risk coronary heart disease (CHD) and stroke in their 60s, and the risk was reduced marginally in women who were on blood pressure lowering drugs. The DPhil project will build on this research to investigate whether HDP leads to an early onset of CVD and examine the risk mediation effects of sociodemographic, lifestyle and clinical factors, in order to develop a CVD risk prediction model for women who had HDP. The research objectives are:

1. To examine the association between HDP and subsequent cardiovascular morbidity and mortality (any CVD, CHD, heart failure, hypertension, peripheral vascular disease, and stroke) in middle- and old-age using data from the Million Women Study.
2. To examine the risk mediation effects of sociodemographic, lifestyle, genetic and clinical factors.
3. To use the findings from the above analyses to generate a risk prediction model.

RESEARCH EXPERIENCE, RESEARCH METHODS AND TRAINING

Training in advanced statistics, epidemiological methods, programming, and scientific writing will be provided. Attendance at seminars, workshops and courses provided by the Department and University will also be encouraged. There will be opportunity to present research work at relevant international/national conferences.

PROSPECTIVE STUDENT

This project will be most suitable for a student who has interest in epidemiology, population health, and long-term outcomes of pregnancy complications. Basic knowledge of epidemiology and statistics is required.