Incident Coronary Heart Disease After Preeclampsia: Role of Reduced Fetal Growth, Preterm Delivery, and Parity

Abstract

Background: Preeclampsia is a severe pregnancy disorder often complicated by reduced fetal growth or preterm delivery and is associated with long-term maternal morbidity and mortality. We aimed to assess the association between preeclampsia phenotypes and risk of subsequent coronary heart disease and maternal cardiovascular mortality.

Methods and results: Women aged 16 to 49 years who gave birth during 1980-2002 and registered in the Medical Birth Registry of Norway were followed prospectively (1-29 years) for an incident major coronary event and mortality through linkage with the Cardiovascular Disease in Norway 1994-2009 (CVDNOR) project and the Norwegian Cause of Death Registry. Preeclampsia was subdivided based on the presence of a child born small for gestational age or preterm delivery. Among 506 350 women with 1 to 5 singleton births, there were 1275 (0.3%) occurrences of major coronary event, 468 (0.1%) cardiovascular deaths, and 5411 (1.1%) deaths overall. Compared with women without preeclampsia, the hazard ratio (95% CI) for major coronary event was 2.1 (1.73-2.65) after preeclampsia alone, 3.3 (2.37-4.57) after preeclampsia in combination with small for gestational age, and 5.4 (3.74-7.74) after preeclampsia in combination with preterm delivery. Analyses distinguishing women with 1 (n=61 352) or >1 (n=281 069) lifetime pregnancy and analyses with cardiovascular mortality as outcome followed the same pattern.

Conclusions: The occurrence of major coronary events was increased among women with preeclampsia and highest for preeclampsia combined with a child born small for gestational age and/or preterm delivery.

Keywords: cardiovascular disease; fetal growth restriction; major coronary events; preeclampsia; preterm delivery.

Figure 1

Flow diagram of number of study patients. Data on 708 614 women with a first birth registered in the Medical Birth Registry of Norway during 1980–2009 were available. MACE indicates major coronary event; PE, preeclampsia; preterm delivery, <37 weeks of gestation; SGA, small for gestational age (<10th percentile).

Figure 2

Kaplan–Meier curves of subsequent risk of major coronary events (MACEs) according to preeclampsia (PE) status (P<0.001). A total of 506 350 women aged 16 to 49 years were included and 1275 MACEs (0.3%) were registered. Preterm delivery indicates <37 weeks of gestation; SGA, small for gestational age (<10th percentile).