A Swedish cohort study found that approximately 30% of pregnant women have a major pregnancy complication, which can lead to an elevated risk for ischemic heart disease that persists for decades.
Using data from 2.1M Swedish women, the authors examined five major types of adverse pregnancy outcomes: preterm delivery (< 37 weeks gestation), small for gestational age, preeclampsia, other hypertensive disorders of pregnancy, and gestational diabetes.
Women with one (or more) adverse pregnancy events had increased risk for CAD out to 46 years post-pregnancy.
- Over the follow-up period (median 25 years, maximum 46 years), 3.8% of women were diagnosed with ischemic heart disease.
- 10 years postpartum, those who had pregnancy-related hypertensive disorders had the greatest CAD risk (adjusted HR 2.09), followed by those with preterm delivery (HR 1.72), preeclampsia (HR 1.54), gestational diabetes (HR 1.30), and a small-for-gestational-age infant (HR 1.10).
- 10-19 years postpartum, having a small-for-gestational-age infant was associated with the highest CAD risk.
- 20-29 years postpartum, gestational diabetes was associated with the highest risk.
- 30-46 years postpartum, adjusted hazard ratios for CAD decreased but remained elevated compared with those without adverse pregnancy outcomes.
Long-term risks of pregnancy complications often go unmentioned between women and their physicians in routine practice. But this study reveals that adverse pregnancy outcomes are important lifelong risk factors for heart disease, and provide an opportunity to identify high-risk women earlier than with traditional risk factors alone.