Maternal age and pregnancy-related cardiovascular complications

Pregnancy-related cardiovascular complications cause substantial morbidity and account for a large proportion of maternal deaths. The relationship between maternal age and pregnancy-related cardiovascular complications remains unclear. Most prior studies categorized patients using an age threshold, and previous studies did not delineate patients' baseline cardiovascular risk versus pregnancy-specific risk. Here we show that pregnancy and the postpartum period are associated with a 7-fold higher risk of major adverse cardiovascular events compared to patients' baseline risk. This relative risk increase does not vary with maternal age. Absolute risk increases are stable at approximately 3 excess events per 1000 pregnancies until 31 years of age, then steadily increase, reaching 10 excess events per 1000 pregnancies by 44 years of age. These findings suggest that aging does not drive pregnancy-specific mechanisms of cardiovascular events. Rather, our findings suggest that pregnancy uniformly amplifies existing cardiovascular risk, resulting in increasing complications as patients accrue more baseline risk with age.