Pregnancy Complications and Cardiovascular Disease Death
What pregnancy-related factors are associated with cardiovascular disease (CVD) death later in life?
Data from the Child Health and Development Studies were used to examine pregnancy events dating from 1959 to 1967, and cardiovascular disease (CVD) death through 2011. This cohort included members of the Kaiser Foundation Health Plan who lived in the East Bay, San Francisco Area. African-American women comprised 22% of the cohort. The majority of the women had one pregnancy during the data collection period (1959-1967). Mortality was assessed by linking with the California Vital Statistics and National Death Index.
A total of 14,062 women (mean age 26 years upon entry) were included. The average age of the cohort was 66 years in 2011. Factors predictive of CVD death included pre-existing hypertension (hazard ratio [HR], 3.5; 95% confidence interval [CI], 2.4-5.1), glycosuria (HR, 4.2; 95% CI, 1.3-13.1), late-onset pre-eclampsia (HR, 2.0; 95% CI, 1.2-3.5), and a decline in hemoglobin over the 2-3 trimesters (HR, 1.7; 95% CI, 1.2-2.7). Additional factors associated with CVD mortality including delivery of a small-for-gestation or preterm infant or early-onset pre-eclampsia. Preterm birth combined with hemorrhage, gestational hypertension, or pre-existing hypertension increased a woman’s risk of CVD death by four- to seven-fold. Pre-eclampsia in combination with pre-existing hypertension was associated with a six-fold risk of CVD death, compared to a four-fold risk associated with pre-existing hypertension without pre-eclampsia.
The authors concluded that combinations of pregnancy-related complications were predictive of CVD mortality, including new risk factors (glycosuria and hemoglobin decline).
These data suggest that pregnancy-related complications may help identify women at increased risk for CVD death. Further research is warranted to understand the mechanisms related to the various factors associated with increased mortality risk and whether prevention of such complications is associated with reduced CVD risk as women age.
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