Cardiovascular Disease in Singleton Offspring Born of Pregnancies Complicated by Placental Abruption: A Population‐Based Retrospective Cohort Study

Background Placental abruption engenders powerful risks of maternal cardiovascular disease (CVD), but offspring risks are lacking. We examine the associations between abruption and the risks of all‐cause mortality and fatal and nonfatal CVD events in the offspring. Methods We designed a retrospective cohort study using the PACER (Placental Abruption and Cardiovascular Event Risk) cohort (births in New Jersey, 1993–2020). We fit Cox proportional hazards models to estimate the abruption‐associated risks of mortality in singleton offspring and of fatal and nonfatal CVD events. These associations were replicated in a sibling‐pair analysis to minimize familial confounding. Results Of 2 949 992 singleton pregnancies, the abruption prevalence was 1% (n=28 641). The median offspring follow‐up was 14.5 years (range 0–28; 41.9 million person‐years). The offspring CVD mortality rates among births with abruption and without abruption were 4 (n=17) and 1 (n=307) per 100 000 person‐years, respectively (adjusted hazard ratio [HR], 4.64 [95% CI, 2.75–7.86]). The corresponding nonfatal CVD rates were 627 (n=2425) and 190 (n=79 360) per 100 000 person‐years, respectively (HR, 2.86 [95% CI, 2.74–2.98]). The risks were higher in analyses restricted to offspring aged <1 year with CVD events. These associations were similar in the sibling pair analyses. Conclusions Offspring born of pregnancies complicated by abruption suffer an increased burden of mortality and CVD. CVD risks associated with abruption are evident during the infancy period and persist throughout the life course. These data underscore how microvascular placental dysfunction due to abruption can affect the offspring's CVD risk.