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September 17, 2018Journal of Women s HealthOpen Access

Preterm Delivery and Maternal Cardiovascular Disease Risk Factors: The Nurses' Health Study II

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Why the study?

Does preterm delivery increase the risk of incident chronic hypertension, type 2 diabetes mellitus, and hypercholesterolemia in parous women?

Population

57,904 parous female United States registered nurses from the Nurses' Health Study II. Key exclusions…

Comparison

Preterm delivery in first pregnancy. vs Term delivery (≥37 weeks) in first pregnancy.

Design

Cohort

Follow-up

Median 28 years for chronic hypertension, 32 years for…

Key result

Preterm delivery was associated with an increased risk of developing chronic hypertension (HR 1.11), type 2 diabetes (HR 1.17), and hypercholesterolemia (HR 1.07) in the years following pregnancy.

Authors

LTLauren J. TanzJSJennifer StuartPWPaige L. Williams

Discussion

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Overview

May warrant enhanced cardiometabolic monitoring after preterm delivery; leaves open whether interventions modify long-term risk.

Study Design

Type

Cohort (n=57,904)

Structured PICO

Does preterm delivery increase the risk of incident chronic hypertension, type 2 diabetes mellitus, and hypercholesterolemia in parous women?

P
Population
57,904 parous women from the Nurses' Health Study II, free of pre-pregnancy cardiovascular risk factors and pregnancy complications, followed for up to 50 years to assess incident cardiovascular risk factors after preterm delivery.
E
Exposure
Preterm delivery (<37 weeks) in first pregnancy (evaluated as an exposure, including moderate preterm [32 to <37 weeks] and very preterm [<32 weeks]).
C
Comparator
Term delivery (≥37 weeks) in first pregnancy.
O
Outcome
Incident chronic hypertension, type 2 diabetes mellitus (T2DM), and hypercholesterolemia.

Main Result

Hazard Ratio: 1.11 (95% CI 1.06–1.17)

Women with a history of preterm delivery are at a significantly higher risk of developing chronic hypertension, T2DM, and hypercholesterolemia, particularly in the first 10 years postpartum, highlighting a critical window for lifestyle interventions.

Limitations

  • Self-reported gestation length, chronic hypertension, and hypercholesterolemia leading to potential misclassification
  • Lack of information on statin use before 1999
  • Exact timing of the development of chronic hypertension and hypercholesterolemia was not known
  • Potential survival bias as participants had to survive to 2001 or 2009 to report pregnancy history
  • Unable to separate spontaneous from medically induced preterm delivery or stratify by small-for-gestational age
  • Study population was 93% white, limiting generalizability to other racial and ethnic groups

Cite This Study

Tanz et al. (2018) conducted a cohort in Maternal cardiovascular disease risk factors (chronic hypertension, type 2 diabetes, hypercholesterolemia) (n=57,904). Preterm delivery (<37 weeks) vs. Term delivery (≥37 weeks) was evaluated on Incident chronic hypertension (HR 1.11, 95% CI 1.06-1.17). Preterm delivery was associated with an increased risk of developing chronic hypertension (HR 1.11), type 2 diabetes (HR 1.17), and hypercholesterolemia (HR 1.07) in the years following pregnancy.

synapsesocial.com/papers/6a8856d226735dbc5f76fc9fhttps://doi.org/10.1089/jwh.2018.7150
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