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

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.