Cargando…

Adverse pregnancy outcomes and long term risk of ischemic heart disease in mothers: national cohort and co-sibling study

OBJECTIVE: To examine the associations between five major adverse pregnancy outcomes and long term risks of ischemic heart disease in mothers. DESIGN: National cohort study. SETTING: Sweden. PARTICIPANTS: All 2 195 266 women with a first singleton delivery in Sweden during 1973-2015. MAIN OUTCOME ME...

Descripción completa

Detalles Bibliográficos
Autores principales: Crump, Casey, Sundquist, Jan, McLaughlin, Mary Ann, Dolan, Siobhan M, Govindarajulu, Usha, Sieh, Weiva, Sundquist, Kristina
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group Ltd. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9890184/
https://www.ncbi.nlm.nih.gov/pubmed/36724989
http://dx.doi.org/10.1136/bmj-2022-072112
_version_ 1784880900906942464
author Crump, Casey
Sundquist, Jan
McLaughlin, Mary Ann
Dolan, Siobhan M
Govindarajulu, Usha
Sieh, Weiva
Sundquist, Kristina
author_facet Crump, Casey
Sundquist, Jan
McLaughlin, Mary Ann
Dolan, Siobhan M
Govindarajulu, Usha
Sieh, Weiva
Sundquist, Kristina
author_sort Crump, Casey
collection PubMed
description OBJECTIVE: To examine the associations between five major adverse pregnancy outcomes and long term risks of ischemic heart disease in mothers. DESIGN: National cohort study. SETTING: Sweden. PARTICIPANTS: All 2 195 266 women with a first singleton delivery in Sweden during 1973-2015. MAIN OUTCOME MEASURES: The main outcome measure was incidence of ischemic heart disease from delivery to 2018, identified from nationwide inpatient and outpatient diagnoses. Cox regression was used to calculate hazard ratios for ischemic heart disease associated with preterm delivery, small for gestational age, pre-eclampsia, other hypertensive disorders of pregnancy, and gestational diabetes, adjusting for other adverse pregnancy outcomes and maternal factors. Co-sibling analyses assessed for confounding by shared familial (genetic and environmental) factors. RESULTS: During 53.6 million person years of follow-up, ischemic heart disease was diagnosed in 83 881 (3.8%) women. All five adverse pregnancy outcomes were independently associated with increased risk of ischemic heart disease. In the 10 years after delivery, adjusted hazard ratios for ischemic heart disease associated with specific adverse pregnancy outcomes were 2.09 (95% confidence interval 1.77 to 2.46) for other hypertensive disorders of pregnancy, 1.72 (1.55 to 1.90) for preterm delivery, 1.54 (1.37 to 1.72) for pre-eclampsia, 1.30 (1.09 to 1.56) for gestational diabetes, and 1.10 (1.00 to 1.21) for small for gestational age. The hazard ratios remained significantly increased even 30-46 years after delivery: 1.47 (1.30 to 1.66) for other hypertensive disorders of pregnancy, 1.40 (1.29 to 1.51) for gestational diabetes, 1.32 (1.28 to 1.36) for pre-eclampsia, 1.23 (1.19 to 1.27) for preterm delivery, and 1.16 (1.13 to 1.19) for small for gestational age. These findings were only partially (<45%) explained by shared familial (genetic or environmental) factors. Women who experienced multiple adverse pregnancy outcomes showed further increases in risk (eg, <10 years after delivery, adjusted hazard ratios associated with 1, 2, or ≥3 adverse pregnancy outcomes were 1.29 (1.19 to 1.39), 1.80 (1.59 to 2.03), and 2.26 (1.89 to 2.70), respectively)). CONCLUSIONS: In this large national cohort, women who experienced any of five major adverse pregnancy outcomes showed an increased risk for ischemic heart disease up to 46 years after delivery. Women with adverse pregnancy outcomes should be considered for early preventive evaluation and long term risk reduction to help prevent the development of ischemic heart disease.
format Online
Article
Text
id pubmed-9890184
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher BMJ Publishing Group Ltd.
record_format MEDLINE/PubMed
spelling pubmed-98901842023-02-02 Adverse pregnancy outcomes and long term risk of ischemic heart disease in mothers: national cohort and co-sibling study Crump, Casey Sundquist, Jan McLaughlin, Mary Ann Dolan, Siobhan M Govindarajulu, Usha Sieh, Weiva Sundquist, Kristina BMJ Research OBJECTIVE: To examine the associations between five major adverse pregnancy outcomes and long term risks of ischemic heart disease in mothers. DESIGN: National cohort study. SETTING: Sweden. PARTICIPANTS: All 2 195 266 women with a first singleton delivery in Sweden during 1973-2015. MAIN OUTCOME MEASURES: The main outcome measure was incidence of ischemic heart disease from delivery to 2018, identified from nationwide inpatient and outpatient diagnoses. Cox regression was used to calculate hazard ratios for ischemic heart disease associated with preterm delivery, small for gestational age, pre-eclampsia, other hypertensive disorders of pregnancy, and gestational diabetes, adjusting for other adverse pregnancy outcomes and maternal factors. Co-sibling analyses assessed for confounding by shared familial (genetic and environmental) factors. RESULTS: During 53.6 million person years of follow-up, ischemic heart disease was diagnosed in 83 881 (3.8%) women. All five adverse pregnancy outcomes were independently associated with increased risk of ischemic heart disease. In the 10 years after delivery, adjusted hazard ratios for ischemic heart disease associated with specific adverse pregnancy outcomes were 2.09 (95% confidence interval 1.77 to 2.46) for other hypertensive disorders of pregnancy, 1.72 (1.55 to 1.90) for preterm delivery, 1.54 (1.37 to 1.72) for pre-eclampsia, 1.30 (1.09 to 1.56) for gestational diabetes, and 1.10 (1.00 to 1.21) for small for gestational age. The hazard ratios remained significantly increased even 30-46 years after delivery: 1.47 (1.30 to 1.66) for other hypertensive disorders of pregnancy, 1.40 (1.29 to 1.51) for gestational diabetes, 1.32 (1.28 to 1.36) for pre-eclampsia, 1.23 (1.19 to 1.27) for preterm delivery, and 1.16 (1.13 to 1.19) for small for gestational age. These findings were only partially (<45%) explained by shared familial (genetic or environmental) factors. Women who experienced multiple adverse pregnancy outcomes showed further increases in risk (eg, <10 years after delivery, adjusted hazard ratios associated with 1, 2, or ≥3 adverse pregnancy outcomes were 1.29 (1.19 to 1.39), 1.80 (1.59 to 2.03), and 2.26 (1.89 to 2.70), respectively)). CONCLUSIONS: In this large national cohort, women who experienced any of five major adverse pregnancy outcomes showed an increased risk for ischemic heart disease up to 46 years after delivery. Women with adverse pregnancy outcomes should be considered for early preventive evaluation and long term risk reduction to help prevent the development of ischemic heart disease. BMJ Publishing Group Ltd. 2023-02-01 /pmc/articles/PMC9890184/ /pubmed/36724989 http://dx.doi.org/10.1136/bmj-2022-072112 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Research
Crump, Casey
Sundquist, Jan
McLaughlin, Mary Ann
Dolan, Siobhan M
Govindarajulu, Usha
Sieh, Weiva
Sundquist, Kristina
Adverse pregnancy outcomes and long term risk of ischemic heart disease in mothers: national cohort and co-sibling study
title Adverse pregnancy outcomes and long term risk of ischemic heart disease in mothers: national cohort and co-sibling study
title_full Adverse pregnancy outcomes and long term risk of ischemic heart disease in mothers: national cohort and co-sibling study
title_fullStr Adverse pregnancy outcomes and long term risk of ischemic heart disease in mothers: national cohort and co-sibling study
title_full_unstemmed Adverse pregnancy outcomes and long term risk of ischemic heart disease in mothers: national cohort and co-sibling study
title_short Adverse pregnancy outcomes and long term risk of ischemic heart disease in mothers: national cohort and co-sibling study
title_sort adverse pregnancy outcomes and long term risk of ischemic heart disease in mothers: national cohort and co-sibling study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9890184/
https://www.ncbi.nlm.nih.gov/pubmed/36724989
http://dx.doi.org/10.1136/bmj-2022-072112
work_keys_str_mv AT crumpcasey adversepregnancyoutcomesandlongtermriskofischemicheartdiseaseinmothersnationalcohortandcosiblingstudy
AT sundquistjan adversepregnancyoutcomesandlongtermriskofischemicheartdiseaseinmothersnationalcohortandcosiblingstudy
AT mclaughlinmaryann adversepregnancyoutcomesandlongtermriskofischemicheartdiseaseinmothersnationalcohortandcosiblingstudy
AT dolansiobhanm adversepregnancyoutcomesandlongtermriskofischemicheartdiseaseinmothersnationalcohortandcosiblingstudy
AT govindarajuluusha adversepregnancyoutcomesandlongtermriskofischemicheartdiseaseinmothersnationalcohortandcosiblingstudy
AT siehweiva adversepregnancyoutcomesandlongtermriskofischemicheartdiseaseinmothersnationalcohortandcosiblingstudy
AT sundquistkristina adversepregnancyoutcomesandlongtermriskofischemicheartdiseaseinmothersnationalcohortandcosiblingstudy