Healio
Healio
October 07, 2015
2 min read
Save

Pregnancy complications may predict later-life CVD death

Multiple pregnancy complications may predict heightened risk for CVD death later in life and identify women needing early intervention efforts, according to recent data in Circulation.

“There have been many advances in preventive cardiology that offer the opportunity to delay or prevent [CVD] death. Knowing which women could benefit most from these interventions is a first step in reducing the burden of [CVD],” Barbara A. Cohn, PhD, director of Child Health and Development Studies, Public Health Institute, Berkeley, California, told Cardiology Today.

Barbara A. Cohn, PhD

Barbara A. Cohn

The researchers used data from the Child Health and Development Studies for 14,062 patients in the Oakland, California, metropolitan area, who were pregnant between 1959 and 1967. The median age of participants was 26 years at enrollment and 66 years at follow-up in 2011.

They examined preeclampsia, pre-existing hypertension, gestational hypertension, glycosuria, hemoglobin, hemorrhage and delivery of a preterm or small for gestational age baby, previous live-born births before observed pregnancy, cigarette smoking during pregnancy and BMI during pregnancy. They regularly assessed participants for weight, BP, urine albumin and glucose, and hemoglobin and hematocrit, and stratified participants by race/ethnicity and socioeconomic rankings.

There were 368 CVD deaths within the cohort. Pregnancy events that increased CVD death included pre-existing hypertension (HR = 3.5; 95% CI, 2.4-5.1), late-onset preeclampsia after week 34 (HR = 2; 95% CI, 1.2-3.5), glycosuria (HR = 4.2; 95% CI, 1.3-13.1) and hemoglobin decline during the second and third trimesters (HR = 1.7; 95% CI, 1.2-2.7).

CVD risk was significantly increased in women with combinations of pregnancy events, including:

  • small for gestational age plus preterm delivery (HR = 2.6; 95% CI, 1.06-6.2);
  • gestational hypertension plus hemoglobin decline (HR = 2.8; 95% CI, 1.15-6.92);
  • preeclampsia plus small for gestational age (HR = 3.7; 95% CI, 1.12-12.1);
  • hemorrhage plus preterm delivery in weeks 35 and 36 (HR = 3.9; 95% CI, 1.63-9.56);
  • small for gestational age plus pre-existing hypertension (HR = 4.8; 95% CI, 1.78-12.91);
  • gestational hypertension plus preterm delivery (HR = 5; 95% CI, 2.64-9.6);
  • preeclampsia plus pre-existing hypertension (HR = 5.6; 95% CI, 2.09-15.18); and
  • preterm delivery plus pre-existing hypertension (HR = 7.1; 95% CI, 3.49-14.55).

Other events associated with early CVD death before age 60 years included:

  • early onset preeclampsia by week 34 (adjusted HR = 3.6; 95% CI, 1.04-12.19);
  • preterm delivery (adjusted HR = 2.1; 95% CI, 1.4-3.01);
  • small for gestational age delivery (adjusted HR = 1.6; 95% CI, 1.02-2.42);
  • combination of any preeclampsia and small for gestational age delivery (HR = 3.7; 95% CI, 1.12-12.1); and
  • the combination of gestational hypertension and preterm delivery (HR = 5; 95% CI, 2.64-9.6).

Additionally, Cohn told Cardiology Today that gestational hypertension alone was a risk factor for CVD in black women, who have the highest risk for CV events.

Overall, 64% of women in the study had no complications, 31% had a single event and 5% had two or more events.

The researchers suggested that doctors consider asking women of all ages about their pregnancy history as a first step toward CVD prevention.

“Prompt intervention may be needed, even for young women who may not see their [CV] health as a high priority,” Cohn said. – by Trish Shea, MA

Disclosure: The researchers report no relevant financial disclosures.

Sources/Disclosures

Collapse
Source: Cirillo PM, Cohn BA. Circulation. 2015;doi:10.1161/CIRCULATIONAHA.113.003901.