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Published on: August 28, 2018
Relationship Between Pregnancy Complications and Subsequent Coronary Artery Disease Assessed by Coronary Computed
Julian L Wichmann1,2, Richard A P Takx1,3, Johanna H Nunez1
1Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (J.L.W., R.A.P.T., J.H.N., R.V., S.E.L., C.N.D.C., R.R.B., S.B., M.R., U.J.S.), Medical University of South Carolina, Charleston.
Insights
Black women with a history of pregnancy complications like gestational diabetes mellitus face higher risks for coronary artery disease (CAD). Gestational diabetes mellitus is an independent risk factor for CAD in Black women, as shown by coronary computed tomographic angiography (CCTA).
Area of Science:
- Cardiology
- Obstetrics & Gynecology
- Radiology
Background:
- Maternal pregnancy complications, including preeclampsia and gestational diabetes mellitus, are linked to increased risk of coronary artery disease (CAD).
- Black women exhibit a higher predisposition to CAD.
- This study investigates CAD prevalence in Black women with and without a history of pregnancy complications.
Purpose of the Study:
- To compare the prevalence and extent of CAD detected by coronary computed tomographic angiography (CCTA).
- To assess CAD risk in Black women with a history of preterm delivery, preeclampsia, or gestational diabetes mellitus versus controls.
Main Methods:
- Retrospective evaluation of patient characteristics and CCTA findings.
- Comparison of Black women with prior preterm delivery (n=154), preeclampsia (n=137), gestational diabetes mellitus (n=148), and a matched control group (n=445).
- Univariate and multivariate analyses to identify CAD risk factors.
Main Results:
- Groups with prior pregnancy complications showed higher rates of any (≥20% narrowing) and obstructive (≥50% narrowing) CAD compared to controls.
- Gestational diabetes mellitus group had the highest rates: 47.3% any CAD and 15.5% obstructive CAD.
- Multivariate analysis confirmed gestational diabetes mellitus as a strong independent risk factor for any (OR 3.26) and obstructive CAD (OR 3.00).
Conclusions:
- Black women with a history of pregnancy complications, especially gestational diabetes mellitus, have a higher prevalence of CAD on CCTA.
- A history of gestational diabetes mellitus is independently associated with both any and obstructive CAD on CCTA in Black women.
Background:
Maternal pregnancy complications, particularly preeclampsia and gestational diabetes mellitus, are described to increase the risk for subsequent coronary artery disease (CAD). In addition, black women are at higher risk for CAD. The objective of this study was to compare the prevalence and extent of CAD as detected by coronary computed tomographic angiography (CCTA) in black women with and without a history of prior pregnancy complications.
Methods:
We retrospectively evaluated patient characteristics and CCTA findings in groups of black women with a prior history of preterm delivery (n=154), preeclampsia (n=137), or gestational diabetes mellitus (n=148), and a matched control group of black women who gave birth without such complications (n=445). Univariate and multivariate analyses were performed to assess risk factors of CAD.
Results:
All groups with prior pregnancy complications showed higher rates of any (≥20% luminal narrowing) and obstructive (≥50% luminal narrowing) CAD (preterm delivery: 29.2% and 9.1%; preeclampsia: 29.2% and 7.3%; and gestational diabetes mellitus: 47.3% and 15.5%) compared with control women (23.8% and 5.4%). After accounting for confounding factors at multivariate analysis, gestational diabetes mellitus remained a strong risk factor of any (odds ratio, 3.26; 95% CI, 2.03-5.22; P<0.001) and obstructive CAD (odds ratio, 3.00; 95% CI, 1.55-5.80; P<0.001) on CCTA.
Conclusions:
Black women with a history of pregnancy complications, particularly gestational diabetes mellitus, have a higher prevalence of CAD on CCTA while only a history of gestational diabetes mellitus was independently associated with any and obstructive CAD on CCTA.
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