Pregnancy Characteristics and Women’s Cardiovascular Health

Fraser, Abigail; Catov, Janet M.; Lawlor, Deborah A; Rich‐Edwards, Janet W.

doi:10.1007/978-3-319-47143-3_8

Cited by 8 publications

(6 citation statements)

References 154 publications

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“…This information will help in starting preventive strategies early. Moreover, the mechanistic pathways between these reproductive factors and risk of cardiovascular disease need to be determined 154…”

Section: Discussionmentioning

confidence: 99%

Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review

Okoth

Chandan

Marshall

et al. 2020

BMJ

246

171

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Objective To consolidate evidence from systematic reviews and meta-analyses investigating the association between reproductive factors in women of reproductive age and their subsequent risk of cardiovascular disease. Design Umbrella review. Data sources Medline, Embase, and Cochrane databases for systematic reviews and meta-analyses from inception until 31 August 2019. Review methods Two independent reviewers undertook screening, data extraction, and quality appraisal. The population was women of reproductive age. Exposures were fertility related factors and adverse pregnancy outcomes. Outcome was cardiovascular diseases in women, including ischaemic heart disease, heart failure, peripheral arterial disease, and stroke. Results 32 reviews were included, evaluating multiple risk factors over an average follow-up period of 7-10 years. All except three reviews were of moderate quality. A narrative evidence synthesis with forest plots and tabular presentations was performed. Associations for composite cardiovascular disease were: twofold for pre-eclampsia, stillbirth, and preterm birth; 1.5-1.9-fold for gestational hypertension, placental abruption, gestational diabetes, and premature ovarian insufficiency; and less than 1.5-fold for early menarche, polycystic ovary syndrome, ever parity, and early menopause. A longer length of breastfeeding was associated with a reduced risk of cardiovascular disease. The associations for ischaemic heart disease were twofold or greater for pre-eclampsia, recurrent pre-eclampsia, gestational diabetes, and preterm birth; 1.5-1.9-fold for current use of combined oral contraceptives (oestrogen and progesterone), recurrent miscarriage, premature ovarian insufficiency, and early menopause; and less than 1.5-fold for miscarriage, polycystic ovary syndrome, and menopausal symptoms. For stroke outcomes, the associations were twofold or more for current use of any oral contraceptive (combined oral contraceptives or progesterone only pill), pre-eclampsia, and recurrent pre-eclampsia; 1.5-1.9-fold for current use of combined oral contraceptives, gestational diabetes, and preterm birth; and less than 1.5-fold for polycystic ovary syndrome. The association for heart failure was fourfold for pre-eclampsia. No association was found between cardiovascular disease outcomes and current use of progesterone only contraceptives, use of non-oral hormonal contraceptive agents, or fertility treatment. Conclusions From menarche to menopause, reproductive factors were associated with cardiovascular disease in women. In this review, presenting absolute numbers on the scale of the problem was not feasible; however, if these associations are causal, they could account for a large proportion of unexplained risk of cardiovascular disease in women, and the risk might be modifiable. Identifying reproductive risk factors at an early stage in the life of women might facilitate the initiation of strategies to modify potential risks. Policy makers should consider incorporating reproductive risk factors as part of the assessment of cardiovascular risk in clinical guidelines. Systematic review registration PROSPERO CRD42019120076.

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Section: Discussionmentioning

confidence: 99%

Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review

Okoth

Chandan

Marshall

et al. 2020

BMJ

246

171

View full text Add to dashboard Cite

show abstract

“…Moreover, the mechanistic pathways between these reproductive factors and risk of cardiovascular disease need to be determined. 154 Prediction models for traditional risk factors for cardiovascular disease could underestimate the true risk of cardiovascular disease in young women because they do not account for risk factors specific to women. 155 A recent systematic review on risk prediction models for cardiovascular disease in women noted that only 1.1% of the 260 articles included in the review investigated the added value of incorporating risk factors specific to women in risk prediction models.…”

Section: Adverse Pregnancy Outcomesmentioning

confidence: 99%

Association Between the Reproductive Health of Young Women and Cardiovascular Disease in Later Life: Umbrella Review

Okoth¹,

Chandan²,

Marshall³

et al. 2021

Obstetric Anesthesia Digest

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Where a licence is displayed above, please note the terms and conditions of the licence govern your use of this document.When citing, please reference the published version. Take down policyWhile the University of Birmingham exercises care and attention in making items available there are rare occasions when an item has been uploaded in error or has been deemed to be commercially or otherwise sensitive.

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“…This is associated with diastolic dysfunction in a small but significant proportion of women at term, all of which revert to normal condition in the postpartum period [19,20]. This is particularly evident in women who develop obstetric complications that, even if transient during the pregnancy state, could be seen as early indicators of a high-risk trajectory for future CVD [21]. Several studies have investigated the possible relationship between impaired hemodynamic adaptation during gestation, adverse pregnancy outcomes (APOs), and maternal cardiovascular diseases (CVD).…”

Section: Maternal Systemic Hemodynamic Adaptations In Fgrmentioning

confidence: 99%

Fetal Growth Restriction: Does an Integrated Maternal Hemodynamic-Placental Model Fit Better?

et al. 2020

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In recent years, a growing interest has arisen regarding the possible relationship between adverse pregnancy outcomes (APOs) and inadequate maternal hemodynamic adaptations to the pregnancy. A possible association between “placental syndromes,” such as preeclampsia (PE) and fetal growth restriction (FGR), and subsequent maternal cardiovascular diseases (CVD) later in life has been reported. The two subtypes of FGR show different pathogenetic and clinical features. Defective placentation, due to a poor trophoblastic invasion of the maternal spiral arteries, is believed to play a central role in the pathogenesis of early-onset PE and FGR. Since placental functioning is dependent on the maternal cardiovascular system, a pre-existent or subsequent cardiovascular impairment may play a key role in the pathogenesis of early-onset FGR. Late FGR does not seem to be determined by a primary abnormal placentation in the first trimester. The pathological pathway of late-onset FGR may be due to a primary maternal cardiovascular maladaptation: CV system shows a flat profile and remains similar to those of non-pregnant women. Since the second trimester, when the placenta is already developed and increases its functional request, a hypovolemic state could lead to placental hypoperfusion and to an altered maturation of the placental villous tree and therefore to an altered fetal growth. Thus, this review focalizes on the possible relationship between maternal cardiac function and placentation in the development of both early and late-onset FGR. A better understanding of maternal hemodynamics in pregnancies complicated by FGR could bring various benefits in clinical practice, improving screening and therapeutic tools.

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Pregnancy Characteristics and Women’s Cardiovascular Health

Cited by 8 publications

References 154 publications

Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review

Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review

Association Between the Reproductive Health of Young Women and Cardiovascular Disease in Later Life: Umbrella Review

Fetal Growth Restriction: Does an Integrated Maternal Hemodynamic-Placental Model Fit Better?

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