What question did this study set out to answer?

To determine whether a broad range of pregnancy complications is associated with a woman's future risk of cardiovascular disease.

February 19, 2019Circulation

Cardiovascular Disease-Related Morbidity and Mortality in Women With a History of Pregnancy Complications

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Why the study?

Most guidelines only recommend postpartum cardiovascular follow-up for preeclampsia, gestational diabetes mellitus, or preterm birth, leaving unclear whether a broader array of pregnancy complications increases future CVD risk.

Does a history of various pregnancy complications increase the risk of subsequent cardiovascular disease in women?

Population

28 993 438 patients across 83 studies

Comparison

Broad array of pregnancy complications vs no complications

Design

Systematic review and meta-analysis of observational studies

Follow-up

Median 7.5 years postpartum

Authors

SGSonia M. GrandiPreventive Cardiology KFKristian B. FilionPreventive Cardiology SYSarah YoonYonsei University

Discussion

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Implication

Pregnancy complications may identify women needing closer CVD surveillance; extends prior associations but remains observational and hypothesis-generating.

Key Points

To determine whether a broad range of pregnancy complications is associated with a woman's future risk of cardiovascular disease.
Searched PubMed, MEDLINE, EMBASE, CINAHL, and Cochrane Library from inception to September 22, 2017, for observational studies evaluating pregnancy complications and subsequent cardiovascular disease.
Identified 83 studies comprising 28,993,438 patients, with individual study sizes between 250 and 2,000,000 and a median follow-up of 7.5 years postpartum.
Calculated pooled odds ratios and 95% intrinsic confidence intervals using likelihood ratio meta-analyses.
Cardiovascular disease risk was markedly higher in women with preeclampsia (OR 2.7; 95% ICI, 2.5–3.0), placental abruption (OR 1.8; 95% ICI, 1.4–2.3), gestational hypertension (OR 1.7; 95% ICI, 1.3–2.2), and gestational diabetes mellitus (OR 1.7; 95% ICI, 1.1–2.5).
Elevated risk was also observed following preterm birth (OR 1.6; 95% ICI, 1.4–1.9) and stillbirth (OR 1.5; 95% ICI, 1.1–2.1).
Low birth weight and small-for-gestational-age birth demonstrated consistent risk trends, whereas miscarriage did not show a clear association with cardiovascular disease.

Structured PICO

Does a history of various pregnancy complications increase the risk of subsequent cardiovascular disease in women?

Population

28,993,438 women across 83 observational studies

Intervention

History of pregnancy complications (hypertensive disorders of pregnancy, placental abruption, preterm birth, gestational diabetes mellitus, low birth weight, small-for-gestational-age birth, stillbirth, and miscarriage)

Comparator

Women without a history of these pregnancy complications

Outcome

Subsequent cardiovascular disease (CVD)hard clinical

A broader array of pregnancy complications, including placental abruption and stillbirth, are associated with increased future CVD risk, highlighting the need for long-term cardiovascular risk assessment in these women.

Cite This Study

Grandi et al. (2019) studied this question.

synapsesocial.com/papers/699a33262dac970dae1eb092 https://doi.org/10.1161/circulationaha.118.036748

Topics

Women and heart disease

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Implication

Pregnancy complications may identify women needing closer CVD surveillance; extends prior associations but remains observational and hypothesis-generating.

Cardiovascular Disease-Related Morbidity and Mortality in Women With a History of Pregnancy Complications

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Cardiovascular Disease-Related Morbidity and Mortality in Women With a History of Pregnancy Complications

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Topics

Also Consider