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Washington, February 2nd
Women who experience any of the five major complications of pregnancy, including preterm birth and pre-eclampsia, are at increased risk of ischemic heart disease up to 46 years after giving birth.
Findings from Sweden were published by the BMJ.
Researchers believe that all major adverse pregnancy outcomes should be recognized as lifelong risk factors for ischemic heart disease, and women should be provided with appropriate care to help prevent its development. said.
Heart disease, a serious condition in which the blood vessels that supply the heart narrow or block, is a leading cause of death for women worldwide.
Adverse pregnancy outcomes are associated with a higher future risk of heart disease. However, while nearly one in three women experience the adverse effects of pregnancy during the reproductive period, few studies have looked at multiple outcomes in the same group of women, so no firm conclusions can be drawn. .
To address this, researchers based in the United States and Sweden set out to examine the association between five major adverse pregnancy outcomes and long-term risk of ischemic heart disease in mothers.
They identified 2,195,266 Swedish women with no history of heart disease who gave birth to one live infant at an average age of 27 years between 1973 and 2015.
We then used national medical records to follow cases of ischemic heart disease from the date of delivery to December 2018 (mean follow-up 25 years, longest 46 years).
The five main adverse pregnancy outcomes of interest were preterm birth (<37 weeks gestation), small relative to gestational age at birth, preeclampsia, other blood pressure disorders of pregnancy, and gestational diabetes.
Other important factors were considered, including maternal age, number of children, education level, income, body mass index, history of smoking, hypertension, diabetes, or high cholesterol.
Overall, 83,881 (3.8%) women with a mean age of 58 years were diagnosed with ischemic heart disease. The results show that women who experienced one of the five major adverse pregnancy outcomes had an increased risk of subsequent ischemic heart disease.
For example, in the first decade after childbirth, the relative rate of ischemic heart disease doubled in women with other hypertensive disorders of pregnancy (46 increases per 100,000 person-years) and increased 1.7-fold in preterm women (100,000 19 per person-year). 100,000), 1.5-fold for those with preeclampsia (12 additional cases per 100,000), 1.3-fold for those with gestational diabetes, and 1.1-fold for those who delivered infants of gestational age, adjusting for all other factors. rear.
Women who experienced some adverse pregnancy outcomes showed a further increased risk. The incidence of ischemic heart disease with 1, 2, or ≥3 adverse pregnancy outcomes was 1.3-fold, 1.8-fold, and 2.3-fold higher in the first decade after delivery (20, 34, 100,000 person-years). and 58 cases). , Respectively.
Most relative rates decreased over time, but continued to increase significantly (1.1- to 1.5-fold) 30–46 years after birth, depending on genetic or environmental factors shared within the family. It was only partially explained.
As this was an observational study, we were unable to identify a cause, suggesting that ischemic heart disease may be underreported, or that maternal smoking, obesity, or other risk factors during pregnancy are underreported. Researchers cannot rule out the possibility that this may have influenced the results.
However, with a large sample size based on highly complete national birth and medical registry data and long follow-up, the researchers found that all major adverse pregnancy outcomes were associated with the lifetime risk of ischemic heart disease. It states that it should be recognized as a factor.
“Women with poor pregnancy outcomes should consider early prophylactic assessment and long-term risk reduction to prevent the development of ischemic heart disease,” they conclude.