Cardiovascular disease risk in women with a history of spontaneous preterm delivery: A systematic review and meta-analysis

Heida, Karst Y.; Velthuis, Birgitta K.; Oudijk, Martijn A.; Reitsma, Johannes B.; Bots, Michiel L.; Franx, Arie; Dunné, Frederique M. van

doi:10.1177/2047487314566758

Cited by 81 publications

(58 citation statements)

References 45 publications

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“…Accumulating evidence suggests that adverse pregnancy outcomes may serve as a screening test for future cardiovascular disease (CVD), the leading cause of morbidity and mortality in women . Prior studies report a 2‐ to 3‐fold increased risk of CVD in women with a history of PTB, even when not complicated by preeclampsia . In a record linkage study, severity and number of small‐for‐gestational‐age infants were associated with future maternal CVD‐related hospitalization or death (ie, coronary heart disease, cerebrovascular events, chronic heart failure) .…”

Section: Introductionmentioning

confidence: 99%

History of Adverse Pregnancy Outcomes, Blood Pressure, and Subclinical Vascular Measures in Late Midlife: SWAN (Study of Women's Health Across the Nation)

Cortés

Catov

Brooks

et al. 2018

JAHA

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BackgroundAdverse pregnancy outcomes, such as preterm birth (PTB), have been associated with elevated risk of maternal cardiovascular disease, but their effect on late midlife blood pressure (BP) and subclinical vascular measures remains understudied.Methods and ResultsWe conducted a cross‐sectional analysis with 1220 multiethnic parous women enrolled in SWAN (Study of Women's Health Across the Nation) to evaluate the impact of self‐reported history of adverse pregnancy outcomes (PTB, small‐for‐gestational‐age, stillbirth), on maternal BP, mean arterial pressure, and subclinical vascular measures (carotid intima‐media thickness, plaque, and pulse wave velocity) in late midlife. We also examined whether these associations were modified by race/ethnicity. Associations were tested in linear and logistic regression models adjusting for sociodemographics, reproductive factors, cardiovascular risk factors, and medications. Women were on average aged 60 years and 255 women reported a history of an adverse pregnancy outcome. In fully adjusted models, history of PTB was associated with higher BP (systolic: β=6.40; SE, 1.62 [P<0.0001] and diastolic: β=3.18; SE, 0.98 [P=0.001]) and mean arterial pressure (β=4.55; SE 1.13 [P<0.0001]). PTB was associated with lower intima‐media thickness, but not after excluding women with prevalent hypertension. There were no significant associations with other subclinical vascular measures.ConclusionsFindings suggest that history of PTB is associated with higher BP and mean arterial pressure in late midlife. Adverse pregnancy outcomes were not significantly related to subclinical cardiovascular disease when excluding women with prevalent hypertension. Future studies across the menopause transition may be important to assess the impact of adverse pregnancy outcomes on midlife progression of BP.

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Section: Introductionmentioning

confidence: 99%

History of Adverse Pregnancy Outcomes, Blood Pressure, and Subclinical Vascular Measures in Late Midlife: SWAN (Study of Women's Health Across the Nation)

Cortés

Catov

Brooks

et al. 2018

JAHA

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“…PTD has been found across numerous studies to be associated with CVD (Table ) . A meta‐analysis of 10 studies from various European countries showed that PTD was associated with a 38% increased risk of ischemic heart disease, 71% increased risk of stroke, and 2‐fold increased risk of overall CVD . Because preeclampsia and IUGR are common reasons for iatrogenic PTD and are each on their own associated with CVD risk, this meta‐analysis only included studies that excluded cases of preeclampsia or IUGR, or adjusted for hypertension/preeclampsia and birthweight.…”

Section: Preterm Deliverymentioning

confidence: 99%

“…[26][27][28][31][32][33][34] A meta-analysis of 10 studies from various European countries showed that PTD was associated with a 38% increased risk of ischemic heart disease, 71% increased risk of stroke, and 2-fold increased risk of overall CVD. 32 Because preeclampsia and IUGR are common reasons for iatrogenic PTD and are each on their own associated with CVD risk, this meta-analysis only included studies that excluded cases of preeclampsia or IUGR, or adjusted for hypertension/preeclampsia and birthweight. An analysis of the NHSII (Nurses' Health Study II) found that PTD was independently associated with a 42% greater risk of CVD after adjusting for prepregnancy lifestyle and CVD risk factors.…”

Section: Preterm Deliverymentioning

confidence: 99%

Adverse pregnancy outcomes and future maternal cardiovascular disease

Hauspurg

Ying

Hubel

et al. 2018

Clinical Cardiology

138

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Cardiovascular disease (CVD) remains the leading cause of death in women. Although traditional risk factors increase later-life CVD, pregnancy-associated complications additionally influence future CVD risk in women. Recent guidelines for the prevention of CVD in women have added adverse pregnancy outcomes as major CVD risk factors. Studies have shown that women with a history of preeclampsia, gestational diabetes, preterm delivery, and delivery of a small-for-gestational-age infant have an increased risk of developing cardiometabolic risk factors and subsequent CVD. A history of multiple adverse pregnancy outcomes further increases this risk. It has been suggested that these pregnancy complications may unmask preexisting elevated CVD risk; however, whether the pathophysiologic changes underlying these conditions directly result in long-term cardiovascular damage is unclear. The purpose of this review was to highlight the associations between adverse pregnancy outcomes and future CVD, and to emphasize the importance of considering pregnancy history in assessing a woman's CVD risk. Targeted efforts to initiate screening and risk-reduction strategies in women with prior history of pregnancy complications, particularly lifestyle modification, may help decrease the burden of CVD in women.

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“…Also, abnormal angiogenic/anti-angiogenic profile in maternal plasma is seen in a subset of patients with spontaneous preterm birth [14], and increased resistance at midtrimester Doppler measurement of uterine artery flow provides an increased risk of spontaneous preterm birth [15]. In addition, women with a spontaneous preterm birth have an increased risk of developing cardiovascular disease later in life [16, 17]. These findings suggest an overlap with other ischemic placental diseases such as preeclampsia.…”

Section: Introductionmentioning

confidence: 99%

Low dose aspirin in the prevention of recurrent spontaneous preterm labour – the APRIL study: a multicenter randomized placebo controlled trial

Visser

Boer

Groot

et al. 2017

BMC Pregnancy Childbirth

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BackgroundPreterm birth (birth before 37 weeks of gestation) is a major problem in obstetrics and affects an estimated 15 million pregnancies worldwide annually. A history of previous preterm birth is the strongest risk factor for preterm birth, and recurrent spontaneous preterm birth affects more than 2.5 million pregnancies each year. A recent meta-analysis showed possible benefits of the use of low dose aspirin in the prevention of recurrent spontaneous preterm birth. We will assess the (cost-)effectiveness of low dose aspirin in comparison with placebo in the prevention of recurrent spontaneous preterm birth in a randomized clinical trial.Methods/designWomen with a singleton pregnancy and a history of spontaneous preterm birth in a singleton pregnancy (22–37 weeks of gestation) will be asked to participate in a multicenter, randomized, double blinded, placebo controlled trial. Women will be randomized to low dose aspirin (80 mg once daily) or placebo, initiated from 8 to 16 weeks up to maximal 36 weeks of gestation. The primary outcome measure will be preterm birth, defined as birth at a gestational age (GA) < 37 weeks. Secondary outcomes will be a composite of adverse neonatal outcome and maternal outcomes, including subgroups of prematurity, as well as intrauterine growth restriction (IUGR) and costs from a healthcare perspective. Preterm birth will be analyzed as a group, as well as separately for spontaneous or indicated onset. Analysis will be performed by intention to treat. In total, 406 pregnant women have to be randomized to show a reduction of 35% in preterm birth from 36 to 23%. If aspirin is effective in preventing preterm birth, we expect that there will be cost savings, because of the low costs of aspirin. To evaluate this, a cost-effectiveness analysis will be performed comparing preventive treatment with aspirin with placebo.DiscussionThis trial will provide evidence as to whether or not low dose aspirin is (cost-) effective in reducing recurrence of spontaneous preterm birth.Trial registrationClinical trial registration number of the Dutch Trial Register: NTR 5675. EudraCT-registration number: 2015-003220-31.

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Cardiovascular disease risk in women with a history of spontaneous preterm delivery: A systematic review and meta-analysis

Abstract: Spontaneous preterm delivery is an independent risk factor for the development of IHD, stroke and overall CVD.

Cited by 81 publications

References 45 publications

History of Adverse Pregnancy Outcomes, Blood Pressure, and Subclinical Vascular Measures in Late Midlife: SWAN (Study of Women's Health Across the Nation)

History of Adverse Pregnancy Outcomes, Blood Pressure, and Subclinical Vascular Measures in Late Midlife: SWAN (Study of Women's Health Across the Nation)

Adverse pregnancy outcomes and future maternal cardiovascular disease

Low dose aspirin in the prevention of recurrent spontaneous preterm labour – the APRIL study: a multicenter randomized placebo controlled trial

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