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

Abstract

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.

Management of prepregnancy, pregnancy, and postpartum obesity from the FIGO Pregnancy and Non‐Communicable Diseases Committee: A FIGO (International Federation of Gynecology and Obstetrics) guideline

“…Higher risk of cardiovascular disease is seen in women who experience pregnancy complications such as gestational hypertension, pre‐eclampsia, gestational diabetes, placental abruption, preterm birth, and stillbirth and these independent risk factors therefore add to the cardiovascular risk associated with obesity 147 . This is especially important for LMICs that disproportionately share the burden of chronic diseases of cardiometabolic health.…”

A phenome-wide analysis of short- and long-run disease incidence following Recurrent Pregnancy Loss using data from a 39-year period

“…Moreover, obstetric complications have also been found to increase the risk of cardiovascular disease (CVD). 17 In recent years, PLs and RPL have been identified as a risk factor for malignancies and cardiovascular disease (CVD). [18][19][20][21][22] The association with CVD has been further explored in a study that found first degree relatives of women with RPL had an increased risk of CVD.…”

Use of antimalarial drugs is associated with a lower risk of preeclampsia in lupus pregnancy: A prospective cohort study

“…14 In addition, an increased risk of future cardiovascular complications in both newborns and women complicated with preeclampsia has been reported. 15,16 In women with SLE, several risk factors for developing preeclampsia have been described. These factors include a decreased glomerular filtration rate before conception, proteinuria at the beginning of pregnancy, elevation of blood pressure in the first trimester, 6 the presence of antiphospholipid antibodies (lupus anticoagulant and anti-β-2 glycoprotein 1), 7,8 history of lupus nephritis, 9,13 chronic hypertension, 9 active SLE before pregnancy, 9 thrombocytopenia 9 and elevated creatinine.…”