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Comparative Study
. 2012 Nov 27:345:e7677.
doi: 10.1136/bmj.e7677.

Cardiovascular mortality after pre-eclampsia in one child mothers: prospective, population based cohort study

Rolv Skjaerven  1 , Allen J Wilcox, Kari Klungsøyr, Lorentz M Irgens, Bjørn Egil Vikse, Lars J Vatten, Rolv Terje Lie
Affiliations
Comparative Study

Cardiovascular mortality after pre-eclampsia in one child mothers: prospective, population based cohort study

Rolv Skjaerven et al. BMJ. .

Abstract

Objective: To assess the association of pre-eclampsia with later cardiovascular death in mothers according to their lifetime number of pregnancies, and particularly after only one child.

Design: Prospective, population based cohort study.

Setting: Medical Birth Registry of Norway.

Participants: We followed 836,147 Norwegian women with a first singleton birth between 1967 and 2002 for cardiovascular mortality through linkage to the national Cause of Death Registry. About 23,000 women died by 2009, of whom 3891 died from cardiovascular causes. Associations between pre-eclampsia and cardiovascular death were assessed by hazard ratios, estimated by Cox regression analyses. Hazard ratios were adjusted for maternal education (three categories), maternal age at first birth, and year of first birth

Results: The rate of cardiovascular mortality among women with preterm pre-eclampsia was 9.2% after having only one child, falling to 1.1% for those with two or more children. With term pre-eclampsia, the rates were 2.8% and 1.1%, respectively. Women with pre-eclampsia in their first pregnancy had higher rates of cardiovascular death than those who did not have the condition at first birth (adjusted hazard ratio 1.6 (95% confidence interval 1.4 to 2.0) after term pre-eclampsia; 3.7 (2.7 to 4.8) after preterm pre-eclampsia). Among women with only one lifetime pregnancy, the increase in risk of cardiovascular death was higher than for those with two or more children (3.4 (2.6 to 4.6) after term pre-eclampsia; 9.4 (6.5 to 13.7) after preterm pre-eclampsia). The risk of cardiovascular death was only moderately elevated among women with pre-eclamptic first pregnancies who went on to have additional children (1.5 (1.2 to 2.0) after term pre-eclampsia; 2.4 (1.5 to 3.9) after preterm pre-eclampsia). There was little evidence of additional risk after recurrent pre-eclampsia. All cause mortality for women with two or more lifetime births, who had pre-eclampsia in first pregnancy, was not elevated, even with preterm pre-eclampsia in first pregnancy (1.1 (0.87 to 1.14)).

Conclusions: Cardiovascular death in women with pre-eclampsia in their first pregnancy is concentrated mainly in women with no additional births. This association might be due to health problems that discourage or prevent further pregnancies rather than to pre-eclampsia itself. As a screening criterion for cardiovascular disease risk, pre-eclampsia is a strong predictor primarily among women with only one child-particularly with preterm pre-eclampsia.

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Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: support from the Norwegian Research Council and the National Institute of Environmental Health Sciences; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work .

Figures

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Fig 1 Cumulative risk of cardiovascular death for women according to pre-eclampsia status at first pregnancy and number of subsequent lifetime pregnancies
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Fig 2 Age specific risk of cardiovascular death in mothers, according to parity and pre-eclampsia. Hazard ratios were adjusted for maternal age, year of first birth, and maternal education (three categories). References within each age group were women with a first birth born to term with no pre-eclampsia, and two or more lifetime births
See this image and copyright information in PMC

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