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History of preterm birth and subsequent cardiovascular disease: a systematic review
Cheryl L Robbins1, Yalonda Hutchings1, Patricia M Dietz1
1Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
Insights
A history of preterm birth (PTB) increases women's lifetime risk for cardiovascular disease (CVD). Women with PTB history face higher risks of CVD morbidity, heart disease, stroke, and CVD-related death.
Area of Science:
- Cardiovascular Health
- Reproductive Health
- Epidemiology
Background:
- Preterm birth (PTB) is a significant global health concern.
- Cardiovascular disease (CVD) is a leading cause of mortality in women.
- The long-term health implications of PTB for maternal cardiovascular health are not fully understood.
Purpose of the Study:
- To systematically review and summarize existing literature on the association between a history of preterm birth (PTB) and subsequent cardiovascular disease (CVD) risk in women.
- To quantify the increased risk of CVD morbidity and mortality associated with PTB.
- To explore the impact of multiple PTB events on CVD risk.
Main Methods:
- A comprehensive literature search was conducted in PubMed/MEDLINE databases for peer-reviewed articles published between January 1, 1995, and September 17, 2012.
- Studies included were limited to English language, human subjects, female participants aged 19 years and older.
- Ten studies assessing the link between PTB history and CVD outcomes were identified and their findings synthesized.
Main Results:
- Women with any history of PTB demonstrated increased risks for CVD morbidity (adjusted hazard ratio [aHR] 1.2-2.9), ischemic heart disease (aHR 1.3-2.1), stroke (aHR 1.7), and atherosclerosis (aHR 4.1) compared to women with term deliveries.
- Four out of five studies indicated that women with a PTB history had double the risk of CVD-related death.
- Two studies revealed a significantly higher risk of CVD morbidity and mortality in women with two or more PTBs compared to those with only one PTB.
Conclusions:
- A history of preterm birth is a significant lifetime risk factor for developing cardiovascular disease in women.
- Women with a history of PTB face elevated risks for various cardiovascular morbidities and mortality.
- Further research is warranted to investigate enhanced CVD risk factor monitoring for women with a history of PTB.
Abstract:
A history of preterm birth (PTB) may be an important lifetime risk factor for cardiovascular disease (CVD) in women. We identified all peer-reviewed journal articles that met study criteria (English language, human studies, female, and adults ≥19 years old), that were found in the PubMed/MEDLINE databases, and that were published between Jan. 1, 1995, and Sept. 17, 2012. We summarized 10 studies that assessed the association between having a history of PTB and subsequent CVD morbidity or death. Compared with women who had term deliveries, women with any history of PTB had increased risk of CVD morbidity (variously defined; adjusted hazard ratio [aHR] ranged from 1.2-2.9; 2 studies), ischemic heart disease (aHR, 1.3-2.1; 3 studies), stroke (aHR, 1.7; 1 study), and atherosclerosis (aHR, 4.1; 1 study). Four of 5 studies that examined death showed that women with a history of PTB have twice the risk of CVD death compared with women who had term births. Two studies reported statistically significant higher risk of CVD-related morbidity and death outcomes (variously defined) among women with ≥2 pregnancies that ended in PTBs compared with women who had at least 2 births but which ended in only 1 PTB. Future research is needed to understand the potential impact of enhanced monitoring of CVD risk factors in women with a history of PTB on risk of future CVD risk.
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