Adverse Pregnancy Outcomes and Prevalent Cardiovascular Disease Among an Urban Cohort in Haiti

BACKGROUND: Adverse pregnancy outcomes (APOs) have been linked with cardiovascular diseases (CVDs) in high-income countries, but evidence from low-income countries like Haiti is limited. OBJECTIVES: The authors investigated the cross-sectional association between APO and prevalent CVD using the Haiti CVD Cohort. METHODS: This analysis included all female participants who completed a reproductive health questionnaire at their annual visit, which captured detailed pregnancy history. We analyzed the relationship between APO and prevalent CVD (defined as heart failure, myocardial infarction, or stroke, as a composite outcome and separately) on enrollment using Poisson regression models, adjusted for traditional risk factors. RESULTS: This analysis included 1,146 women with a median age of 44 years (IQR: 31-55 years). Most participants lived in severe poverty, with 68.0% reporting income <1 USD/day, 67.0% reporting unemployment, and 46.0% reporting only primary education or less. APO were common, with 61.7% (n = 623) experiencing at least 1 APO. APO were significantly associated with heart failure in both age-adjusted (prevalence ratio [PR]: 1.54; 95% CI: 1.11-2.12) and fully adjusted models (PR: 1.44; 95% CI: 1.04-1.99). APOs were not significantly associated with prevalent stroke (PR: 1.05; 95% CI: 0.52-2.11). In the fully adjusted model, grand multiparity (5+ live births, reported by 20% [n = 230]) was associated with both CVD (PR: 1.54; 95% CI: 1.14-2.07) and heart failure (PR: 1.62; 95% CI: 1.17-2.24). CONCLUSIONS: CVD was more common in women with a history of APO or grand multiparity, driven primarily by high heart failure prevalence in this relatively young sample of women living in urban Haiti.