Postmenopausal hormone therapy in prior pre-eclamptic women: a nationwide cohort study in Finland

Abstract

Objective

We compared the trends of hormone therapy (HT) use among women with and without a history of pre-eclampsia.

Methods

This national cohort study consisted of women with a pre-eclamptic pregnancy (n = 31,688) or a normotensive pregnancy (n = 91,726) (controls) during 1969–1993. The data on their use of HT during 1994–2019 were traced from the National Medicine Reimbursement Register.

Results

Both women with a history of pre-eclampsia and controls initiated HT at a mean age of 49.9 years. Cumulative HT™ use during the total follow-up did not differ between the groups (31.1% vs. 30.6%, p = 0.066). However, HT use in previously pre-eclamptic women was less common in 1994–2006 (20.2% vs. 22.4%, p < 0.001) and more common in 2007–2019 (22.1% vs. 21.1%, p < 0.001) than in controls. This trend was also seen in the annual changes of HT starters. Women with a history of pre-eclampsia used HT for a shorter time (6.3 vs. 7.1 years, p < 0.001).

Conclusions

In contrast to controls, HT use in previously pre-eclamptic women increased during the last half of the follow-up. This may reflect the changes in the international recommendations, the increased awareness of pre-eclampsia-related cardiovascular risk later in life and the aim to diminish this risk with HT.

摘要

目的: 我们比较了有和没有子痫前期病史的妇女使用激素治疗(HT)的趋势。

方法: 这项全国性队列研究包括1969-1993年期间子痫前期妊娠(n= 31, 688)或血压正常妊娠(n= 91, 726)(对照)的妇女。她们在1994-2019年期间使用HT的数据来自国家药品报销登记册。

结果: 有子痫前期病史的妇女和对照组开始HT的平均年龄为49.9岁。在整个随访期间, 两组之间的累积HT™应用率没有差异(31.1% vs. 30.6%, p = 0.066)。然而, 在1994-2006年, HT在子痫前期史妇女中的应用不太常见(20.2% vs. 22.4%, p < 0.001), 2007-2019年更常见(22.1% vs. 21.1%, p < 0.001)。这一趋势也出现在HT启动时机的变化时。有子痫前期病史的妇女使用HT的时间较短(6.3 vs. 7.1年, p < 0.001)。

结论: 与对照组相比, 在随访的后半期, 子痫前期史妇女使用HT的情况有所增加。这可能反映了国际建议的变化, 对子痫前期相关心血管风险的认识提高, 以及减少HT风险的目的。

Keywords:

• Pre-eclampsia
• hypertensive disorder in pregnancy
• hormone therapy
• menopausal hormone therapy
• estradiol
• progestin
• tibolone
• cardiovascular disease

Potential conflict of interest

H. Savolainen-Peltonen has been a member of the advisory board of Ferring Pharmaceuticals and a consultant to Merck and Orion. T. S. Mikkola has received honoraria for lectures from Abbott, Viatris and Orion.

Source of funding

The study was supported by Research Grant of Helsinki University Hospital [TYH2019302]; Research Grant of the Finnish Academy of Sciences [UAK1017SAV].

Data availability statement

The data generated and analyzed in this study are not publicly available.