Maternal placental syndromes were associated with a higher risk of premature cardiovascular disease compared to women without these syndromes (500 vs 200 per million person-years; HR 2.0, 95% CI 1.7-2.2).
Cohort (n=1,030,000)
Do maternal placental syndromes increase the risk of premature cardiovascular disease in women?
Maternal placental syndromes are associated with a twofold increased risk of premature cardiovascular disease, highlighting the need for postpartum cardiovascular risk assessment and lifestyle modification.
Hazard Ratio: 2 (95% CI 1.7–2.2)
Absolute Event Rate: 500% vs 200%
BACKGROUND: Maternal placental syndromes, including the hypertensive disorders of pregnancy and abruption or infarction of the placenta, probably originate from diseased placental vessels. The syndromes arise most often in women who have metabolic risk factors for cardiovascular disease, including obesity, pre-pregnancy hypertension, diabetes mellitus, and dyslipidaemia. Our aim was to assess the risk of premature vascular disease in women who had had a pregnancy affected by maternal placental syndromes. METHODS: We did a population-based retrospective cohort study in Ontario, Canada, of 1.03 million women who were free from cardiovascular disease before their first documented delivery. We defined the following as maternal placental syndromes: pre-eclampsia, gestational hypertension, placental abruption, and placental infarction. Our primary endpoint was a composite of cardiovascular disease, defined as hospital admission or revascularisation for coronary artery, cerebrovascular, or peripheral artery disease at least 90 days after the delivery discharge date. FINDINGS: The mean (SD) age of participants was 28.2 (5.5) years at the index delivery, and 75 380 (7%) women were diagnosed with a maternal placental syndrome. The incidence of cardiovascular disease was 500 per million person-years in women who had had a maternal placental syndrome compared with 200 per million in women who had not (adjusted hazard ratio HR 2.0, 95 CI 1.7-2.2). This risk was higher in the combined presence of a maternal placental syndrome and poor fetal growth (3.1, 2.2-4.5) or a maternal placental syndrome and intrauterine fetal death (4.4, 2.4-7.9), relative to neither. INTERPRETATION: The risk of premature cardiovascular disease is higher after a maternal placental syndrome, especially in the presence of fetal compromise. Affected women should have their blood pressure and weight assessed about 6 months postpartum, and a healthy lifestyle should be emphasised.
“We found that women who had placental syndromes had double the risk of developing premature cardiovascular disease, compared with women who didn't have one of those maternal placental syndromes.”
Ray et al. (2005) conducted a cohort in Maternal placental syndromes (n=1,030,000). Maternal placental syndromes vs. No maternal placental syndrome was evaluated on Composite of cardiovascular disease, defined as hospital admission or revascularisation for coronary artery, cerebrovascular, or peripheral artery disease at least 90 days after delivery (HR 2.0, 95% CI 1.7-2.2). Maternal placental syndromes were associated with a higher risk of premature cardiovascular disease compared to women without these syndromes (500 vs 200 per million person-years; HR 2.0, 95% CI 1.7-2.2).