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Cardiovascular Disease-Related Morbidity and Mortality in Women With a History of Pregnancy Complications

Sonia M Grandi1,2, Kristian B Filion1,2,3, Sarah Yoon1,2

  • 1Department of Epidemiology, Biostatisticcs and Occupational Health, McGill University, Montreal, QC, Canada (S.G., K.F., S.Y., H.A., C.D., R.P.).

Circulation
|February 20, 2019
PubMed

Insights

Pregnancy complications like placental abruption and stillbirth increase future cardiovascular disease (CVD) risk. Women need long-term CVD risk assessment beyond the postpartum period.

Area of Science:

  • Obstetrics and Gynecology
  • Cardiology
  • Epidemiology

Background:

  • Pregnancy complications are linked to increased cardiovascular disease (CVD) risk.
  • Current guidelines focus postpartum follow-up on preeclampsia, gestational diabetes mellitus, and preterm birth.
  • The association between other pregnancy complications and future CVD risk requires further investigation.

Purpose of the Study:

  • To systematically review and analyze the association between a wide range of pregnancy complications and subsequent CVD risk.
  • To determine if complications beyond those currently recommended warrant postpartum cardiovascular risk assessment.

Main Methods:

  • Systematic literature search of PubMed, MEDLINE, EMBASE, CINAHL, and Cochrane Library up to September 2017.
  • Inclusion of observational studies examining hypertensive disorders of pregnancy, placental abruption, preterm birth, gestational diabetes mellitus, low birth weight, small-for-gestational-age birth, stillbirth, and miscarriage.
  • Likelihood ratio meta-analyses to calculate pooled odds ratios (OR) and 95% confidence intervals (ICI) for CVD risk.

Main Results:

  • The review included 84 studies encompassing over 28 million patients with a median postpartum follow-up of 7.5 years.
  • Elevated CVD risk was observed for gestational hypertension (OR 1.7), preeclampsia (OR 2.7), placental abruption (OR 1.8), preterm birth (OR 1.6), gestational diabetes mellitus (OR 1.7), and stillbirth (OR 1.5).
  • A trend for increased CVD risk was noted for low birth weight and small-for-gestational-age birth weight, but not for miscarriage.

Conclusions:

  • A broader spectrum of pregnancy complications, including placental abruption and stillbirth, is associated with a significantly higher risk of future cardiovascular disease.
  • These findings underscore the importance of comprehensive cardiovascular risk assessment and management for women with a history of various pregnancy complications, extending beyond the immediate postpartum period.
Abstract

Keywords:
cardiovascular diseasematernal healthmeta-analysispregnancy complicationssystematic review

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