Adverse pregnancy outcomes could increase late ASCVD risk
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Adverse pregnancy outcomes, particularly hypertensive disorders of pregnancy and low birth weight, were independently linked to atherosclerotic CVD in postmenopausal women, researchers found.
“The American Heart Association and [American College of Cardiology] have recommended taking key parts of the pregnancy history and using it potentially as a risk enhancer when you’re discussing statin initiation for patients,” Nisha I. Parikh, MD, MPH, associate professor of medicine in the division of cardiology at University of California, San Francisco School of Medicine and senior author of the paper, told Healio. “Our study highlights what specific factors at least in the older cohort might be important to consider, that is the hypertensive disorders of pregnancy and having a low birth weight baby.”
Data from Women’s Health Initiative
In this study published in JAMA Cardiology, Marc Meller Sondergaard, BSc(Med), medical assistant at Aalborg University School of Medicine and Health in Denmark, and colleagues analyzed data from 46,805 postmenopausal women (median age at enrollment, 60 years) from the Women’s Health Initiative aged 50 to 79 years. Women reported on their reproductive history at baseline and completed a questionnaire in 2017 regarding their history of adverse pregnancy outcomes, including hypertensive disorders of pregnancy, gestational diabetes, low birth weight (< 2.49 kg), high birth weight (> 4.08 kg), preeclampsia and preterm delivery by 3 weeks or more. Several ASCVD risk factors were assessed, including hypertension, hyperlipidemia, smoking status and diabetes.
The primary outcome for this study was ASCVD, defined as stroke, MI, peripheral artery disease or coronary revascularization.
One or more adverse pregnancy outcomes were reported by 28.8% of women. ASCVD was more common in women with adverse pregnancy outcomes compared with those without these outcomes (7.6% vs. 5.8%).
When analyzed separately, each adverse pregnancy outcome was significantly linked to ASCVD. After adjusting for traditional ASCVD risk factors, several outcomes remained significant, including hypertensive disorders of pregnancy, gestational diabetes, preterm delivery and low birth weight. When adverse pregnancy outcomes were analyzed together, low birth weight (OR = 1.18; 95% CI, 1.03-1.35) and hypertensive disorders of pregnancy (OR = 1.34; 95% CI, 1.15-1.54) were independently associated with ASCVD.
“Although we know that adverse pregnancy outcomes are associated with cardiovascular disease, we haven’t had a large multiethnic cohort look at this question in the United States,” Parikh said in an interview. “In some ways, this study was a really important confirmation of what we already know.”
Findings were materially unchanged after further adjustment for income, race/ethnicity, BMI, education, parity and breastfeeding.
“Further research needs to be done regarding if there are any other primary prevention strategies like aspirin, for instance, and also if there are any differences in the way that we follow-up patients after their adverse pregnancy outcome with that aim of preventing cardiovascular disease,” Parikh told Healio. “The reason that aspirin may be important to study in the context of primary CVD prevention following an [adverse pregnancy outcome] is that it is currently used in pregnancy to prevent preeclampsia in high-risk women. Data in low- and middle-income countries also suggest aspirin prevents preterm birth if given during pregnancy.”
Addition to electronic medical records
In a related editorial, Odayme Quesada, MD, fellow at Barbra Streisand Women’s Heart Center at Cedars-Sinai Smidt Heart Institute, and colleagues wrote: “These new data support generation of new hypotheses regarding links between adverse pregnancy outcomes and CVD to be tested for sex-specific, mechanistic understanding and novel treatments. This will require a focus of adverse pregnancy outcome electronic health record inclusion, entry and use, as well as investigative study of an issue under our noses, pregnancy, to improve human health.”
“[Adding this question to electronic medical records] is really a unique, creative suggestion that might address the fact that many of us don’t consider these factors in assessing a woman’s risk,” Parikh told Healio. “Eighty-five percent of women do get pregnant, so they will definitely have a history of these adverse pregnancy outcomes being either yes or no.”
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For more information:
Nisha I. Parikh, MD, MPH, can be reached at nisha.parikh@ucsf.edu.
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