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This document reflects emerging clinical and scientific advances on the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Local institutions can dictate amendments to these opinions. They should be well documented if modified at the local level. None of these contents may be reproduced in any form without prior written permission of the SOGC.

Random measurement error is a pervasive problem in medical research, which can introduce bias to an estimate of the association between a risk factor and a disease or make a true association statistically non-significant. Hutcheon and colleagues explain when, why, and how random measurement error introduces bias and provides strategies for researchers to minimise the problem

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Background: Women with a history of certain pregnancy complications are at higher risk for cardiovascular (CVD) disease. However, most clinical guidelines only recommend postpartum follow-up of those with a history of preeclampsia, gestational diabetes mellitus, or preterm birth. This systematic review was undertaken to determine if there is an association between a broader array of pregnancy complications and the future risk of CVD. Methods: We systematically searched PubMed, MEDLINE and EMBASE (via Ovid), CINAHL, and the Cochrane Library from inception to September 22, 2017, for observational studies of the association between the hypertensive disorders of pregnancy, placental abruption, preterm birth, gestational diabetes mellitus, low birth weight, small-for-gestational-age birth, stillbirth, and miscarriage and subsequent CVD. Likelihood ratio meta-analyses were performed to generate pooled odds ratios (OR) and 95% intrinsic confidence intervals (ICI). Results: Our systematic review included 83 studies (28 993 438 patients). Sample sizes varied from 250 to 2 000 000, with a median follow-up of 7.5 years postpartum. The risk of CVD was highest in women with gestational hypertension (OR 1.7; 95% ICI, 1.3–2.2), preeclampsia (OR 2.7; 95% ICI, 2.5–3.0), placental abruption (OR 1.8; 95% ICI, 1.4–2.3), preterm birth (OR 1.6; 95% ICI, 1.4–1.9), gestational diabetes mellitus (OR 1.7; 95% ICI, 1.1–2.5), and stillbirth (OR 1.5; 95% ICI, 1.1–2.1). A consistent trend was seen for low birth weight and small-for-gestational-age birth weight but not for miscarriage. Conclusions: Women with a broader array of pregnancy complications, including placental abruption and stillbirth, are at increased risk of future CVD. The findings support the need for assessment and risk factor management beyond the postpartum period.