Log in to MyACC
History of Adverse Pregnancy Outcomes and CAD Assessed by CTA
Quick Takes
- Among Swedish women undergoing coronary CTA screening, there was a statistically significant association between history of adverse pregnancy outcomes and image-identified coronary artery disease (CAD).
- These associations were primarily found for hypertensive disorders of pregnancy, i.e., preeclampsia or gestational hypertension, which were associated with all five CAD indexes.
- A history of preeclampsia or gestational hypertension was associated with a more than twice higher risk of subclinical obstructive and widespread CAD.
Study Questions:
What is the association between history of adverse pregnancy outcomes and coronary artery disease (CAD) assessed by coronary computed tomography angiography (CTA) screening?
Methods:
The investigators conducted a cross-sectional study of a population-based cohort of women in Sweden (n = 10,528) with ≥1 deliveries in 1973 or later, ascertained via the Swedish National Medical Birth Register, who subsequently participated in the Swedish Cardiopulmonary Bioimage Study at age 50-65 (median, 57.3) years in 2013-2018. Delivery data were prospectively collected. Adverse pregnancy outcomes included preeclampsia, gestational hypertension, preterm delivery, small-for-gestational-age infant, and gestational diabetes. The reference category included women with no history of these exposures. Coronary CTA indexes included any coronary atherosclerosis, significant stenosis, noncalcified plaque, segment involvement score of ≥4, and coronary artery calcium score >100.
Results:
A median 29.6 (interquartile range, 25.0-34.9) years after first registered delivery, 18.9% of women had a history of adverse pregnancy outcomes, with specific pregnancy histories ranging from 1.4% (gestational diabetes) to 9.5% (preterm delivery). The prevalence of any coronary atherosclerosis in women with a history of any adverse pregnancy outcome was 32.1% (95% confidence interval [CI], 30.0%-34.2%), which was significantly higher (prevalence difference, 3.8% [95% CI, 1.6%-6.1%]; prevalence ratio, 1.14 [95% CI, 1.06-1.22]) compared with reference women. History of gestational hypertension and preeclampsia were both significantly associated with higher and similar prevalence of all outcome indexes. For preeclampsia, the highest prevalence difference was observed for any coronary atherosclerosis (prevalence difference, 8.0% [95% CI, 3.7%-12.3%]; prevalence ratio, 1.28 [95% CI, 1.14-1.45]), and the highest prevalence ratio was observed for significant stenosis (prevalence difference, 3.1% [95% CI, 1.1%-5.1%]; prevalence ratio, 2.46 [95% CI, 1.65-3.67]). In adjusted models, odds ratios for preeclampsia ranged from 1.31 (95% CI, 1.07-1.61) for any coronary atherosclerosis to 2.21 (95% CI, 1.42-3.44) for significant stenosis. Similar associations were observed for history of preeclampsia or gestational hypertension among women with low predicted cardiovascular risk.
Conclusions:
The authors report that among Swedish women undergoing coronary CTA screening, there was a statistically significant association between history of adverse pregnancy outcomes and image-identified CAD.
Perspective:
This study reports that among Swedish women undergoing coronary CTA screening, there was a statistically significant association between history of adverse pregnancy outcomes and image-identified CAD, including among women estimated to be at low risk of cardiovascular disease. Furthermore, these associations were primarily found for hypertensive disorders of pregnancy, i.e., preeclampsia or gestational hypertension, which were associated with all five CAD indexes (coronary atherosclerosis, significant stenosis, noncalcified plaque, segment involvement score of ≥4, and coronary artery calcium score >100). A history of preeclampsia or gestational hypertension was associated with a more than twice higher risk of subclinical obstructive and widespread CAD. Additional research is needed to understand the clinical importance of these associations.
Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Imaging, CHD and Pediatrics and Interventions, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Interventions and Coronary Artery Disease, Interventions and Imaging, Interventions and Vascular Medicine, Angiography, Computed Tomography, Nuclear Imaging, Hypertension
Keywords: Angiography, Coronary Angiography, Atherosclerosis, Coronary Artery Disease, Coronary Stenosis, Computed Tomography Angiography, Diabetes, Gestational, Diagnostic Imaging, Hypertension, Pregnancy-Induced, Infant, Newborn, Myocardial Ischemia, Plaque, Atherosclerotic, Pre-Eclampsia, Pregnancy, Premature Birth, Risk Factors, Secondary Prevention, Vascular Diseases, Women
< Back to Listings
