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(Stroke. 2009;40:1176.)
© 2009 American Heart Association, Inc.

Go Red for Women

Pre-Eclampsia Is Associated With Increased Risk of Stroke in the Adult Offspring

The Helsinki Birth Cohort Study

Eero Kajantie, MD; Johan G. Eriksson, MD; Clive Osmond, PhD; Kent Thornburg, PhD David J.P. Barker, FRS

From the Institute for Health and Welfare (E.K., J.G.E.), Department of Chronic Disease Prevention, Helsinki, Finland; the Department of General Practice and Primary Health Care (J.G.E.), University of Helsinki, Helsinki, Finland; MRC Epidemiology Resource Centre (University of Southampton; C.O., D.J.P.B.), Southampton General Hospital, Southampton, UK; and the Heart Research Center (K.T., D.J.P.B.), Oregon Health and Science University, Portland, Ore.

Correspondence to Eero Kajantie, MD, Institute for Health and Welfare, Department of Chronic Disease Prevention, Mannerheimintie 166, 00300 Helsinki, Finland. E-mail eero.kajantie{at}helsinki.fi

Background and Purpose— Women who develop pre-eclampsia in pregnancy are at increased risk of cardiovascular disease. The offspring from pregnancies complicated by pre-eclampsia have higher blood pressures during childhood, but little is known about their long-term health. We hypothesized that pre-eclampsia would lead to an increased risk of cardiovascular disease in the offspring.

Methods— We traced 6410 babies born in Helsinki, Finland, from 1934 to 1944. We used the mothers’ blood pressure levels and the presence of proteinuria during pregnancy to define pre-eclampsia and gestational hypertension without proteinuria according to modern criteria.

Results— Two hundred eighty-four of the pregnancies were complicated by pre-eclampsia (120 with nonsevere and 164 with severe disease) and 1592 by gestational hypertension. The crude hazard ratio for all forms of stroke among people whose mothers had pre-eclampsia was 1.9 (1.2 to 3.0; P=0.01); among people whose mothers had gestational hypertension, it was 1.4 (1.0 to 1.8; P=0.03). There was no evidence that these pregnancy disorders were associated with coronary heart disease in the offspring. Pre-eclampsia, in particular severe disease, was associated with a reduced mean head circumference at birth, whereas gestational hypertension was associated with an increased head circumference in relation to body length.

Conclusions— People born after pregnancies complicated by pre-eclampsia or gestational hypertension are at increased risk of stroke. The underlying processes may include a local disorder of the blood vessels of the brain as a consequence of either reduced brain growth or impaired brain growth leading to "brain-sparing" responses in utero.

Key Words: coronary artery disease • pre-eclampsia • pregnancy • pregnancy complications • stroke