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. 2023 Feb 1:380:e072112.
doi: 10.1136/bmj-2022-072112.

Adverse pregnancy outcomes and long term risk of ischemic heart disease in mothers: national cohort and co-sibling study

Casey Crump  1   2 , Jan Sundquist  3 , Mary Ann McLaughlin  2   4 , Siobhan M Dolan  5 , Usha Govindarajulu  2 , Weiva Sieh  2   6 , Kristina Sundquist  3
Affiliations

Adverse pregnancy outcomes and long term risk of ischemic heart disease in mothers: national cohort and co-sibling study

Casey Crump et al. BMJ. .

Abstract

Objective: To examine the associations between five major adverse pregnancy outcomes and long term risks of ischemic heart disease in mothers.

Design: National cohort study.

Setting: Sweden.

Participants: All 2 195 266 women with a first singleton delivery in Sweden during 1973-2015.

Main outcome measures: The main outcome measure was incidence of ischemic heart disease from delivery to 2018, identified from nationwide inpatient and outpatient diagnoses. Cox regression was used to calculate hazard ratios for ischemic heart disease associated with preterm delivery, small for gestational age, pre-eclampsia, other hypertensive disorders of pregnancy, and gestational diabetes, adjusting for other adverse pregnancy outcomes and maternal factors. Co-sibling analyses assessed for confounding by shared familial (genetic and environmental) factors.

Results: During 53.6 million person years of follow-up, ischemic heart disease was diagnosed in 83 881 (3.8%) women. All five adverse pregnancy outcomes were independently associated with increased risk of ischemic heart disease. In the 10 years after delivery, adjusted hazard ratios for ischemic heart disease associated with specific adverse pregnancy outcomes were 2.09 (95% confidence interval 1.77 to 2.46) for other hypertensive disorders of pregnancy, 1.72 (1.55 to 1.90) for preterm delivery, 1.54 (1.37 to 1.72) for pre-eclampsia, 1.30 (1.09 to 1.56) for gestational diabetes, and 1.10 (1.00 to 1.21) for small for gestational age. The hazard ratios remained significantly increased even 30-46 years after delivery: 1.47 (1.30 to 1.66) for other hypertensive disorders of pregnancy, 1.40 (1.29 to 1.51) for gestational diabetes, 1.32 (1.28 to 1.36) for pre-eclampsia, 1.23 (1.19 to 1.27) for preterm delivery, and 1.16 (1.13 to 1.19) for small for gestational age. These findings were only partially (<45%) explained by shared familial (genetic or environmental) factors. Women who experienced multiple adverse pregnancy outcomes showed further increases in risk (eg, <10 years after delivery, adjusted hazard ratios associated with 1, 2, or ≥3 adverse pregnancy outcomes were 1.29 (1.19 to 1.39), 1.80 (1.59 to 2.03), and 2.26 (1.89 to 2.70), respectively)).

Conclusions: In this large national cohort, women who experienced any of five major adverse pregnancy outcomes showed an increased risk for ischemic heart disease up to 46 years after delivery. Women with adverse pregnancy outcomes should be considered for early preventive evaluation and long term risk reduction to help prevent the development of ischemic heart disease.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: support from the National Heart, Lung, and Blood Institute at the National Institutes of Health, Swedish Research Council, Swedish Heart-Lung Foundation, and ALF project grant, Region Skåne/Lund University, Sweden for the submitted work; no financial relationships with any organizations 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

Fig 1
Fig 1
Adjusted hazard ratios for associations between adverse pregnancy outcomes and ischemic heart disease by time since delivery, Sweden, 1973-2018. Whiskers represent 95% confidence intervals
Fig 2
Fig 2
Interactions between adverse pregnancy outcomes and risk of ischemic heart disease (IHD) at ≤46 years after delivery, 1973-2018, Sweden (P≤0.003 for each interaction on the additive scale)
See this image and copyright information in PMC

Comment in

References

    1. Benjamin EJ, Muntner P, Alonso A, et al. American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee . Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019;139:e56-528. 10.1161/CIR.0000000000000659 - DOI - PubMed
    1. Mehta LS, Beckie TM, DeVon HA, et al. American Heart Association Cardiovascular Disease in Women and Special Populations Committee of the Council on Clinical Cardiology, Council on Epidemiology and Prevention, Council on Cardiovascular and Stroke Nursing, and Council on Quality of Care and Outcomes Research . Acute Myocardial Infarction in Women: A Scientific Statement From the American Heart Association. Circulation 2016;133:916-47. 10.1161/CIR.0000000000000351 - DOI - PubMed
    1. Søndergaard MM, Hlatky MA, Stefanick ML, et al. . Association of Adverse Pregnancy Outcomes With Risk of Atherosclerotic Cardiovascular Disease in Postmenopausal Women. JAMA Cardiol 2020;5:1390-8. 10.1001/jamacardio.2020.4097 - DOI - PMC - PubMed
    1. Fraser A, Nelson SM, Macdonald-Wallis C, et al. . Associations of pregnancy complications with calculated cardiovascular disease risk and cardiovascular risk factors in middle age: the Avon Longitudinal Study of Parents and Children. Circulation 2012;125:1367-80. 10.1161/CIRCULATIONAHA.111.044784 - DOI - PMC - PubMed
    1. Grandi SM, Filion KB, Yoon S, et al. . Cardiovascular Disease-Related Morbidity and Mortality in Women With a History of Pregnancy Complications. Circulation 2019;139:1069-79. 10.1161/CIRCULATIONAHA.118.036748 - DOI - PubMed