Grant: Catalyst Grant : Maternal Health: From Pre-Conception to the Empty Nest

High blood pressure affects 3 to 5% of all pregnancies; affected women often deliver prematurely, have premature separation of the placenta, & poor fetal growth & fetal death. Maternal risk factors for these adverse events in pregnancy include obesity, insulin resistance, diabetes mellitus, &, especially, chronic hypertension. These same risk factors are also associated with adult-onset decline in heart muscle function, irregular heart rhythms ("cardiac dysrhythmias") & eventual heart failure. Hence, high blood pressure in pregnancy & related adverse events in pregnancy may be a strong marker of early onset dysrhythmias & heart failure, yet, these associations have not been formally evaluated. The proposed Cardiac Arrhythmias after Maternal Placental Syndromes (CAMPS) Study will evaluate whether women with high blood pressure in pregnancy & related adverse events are at long-term risk of dysrhythmias & heart failure. CAMPS will be an 18-year retrospective cohort study of 2,000,000 women with an obstetrical delivery. We will use pre-existing healthcare datasets located at the Institute for Clinical Evaluations Sciences, enabling us to commence a new area of research using an efficient, adequately-powered epidemiological study with pre-existing provincial datasets. Determining the absolute risk of dysrhythmias & heart failure in CAMPS should enable us to proceed with an intended long-term post-partum cohort registry. In this planned registry, we hope to prospectively enrol 10,000 women with & without high blood pressure in pregnancy and related adverse events in pregnancy, & evaluate their risk of cardiac disease within 5 years of delivery, including asymptomatic ("silent") dysrhythmias. Each year, participants will undergo measurements of blood pressure, weight, 12-lead electrocardiography, & we would capture clinical events as well. Thus, the current CAMPS study can direct us in terms of sample size feasibility & outcome event rates for this planned registry.