Pregnancy Complications and Cardiovascular Disease Death: Fifty-Year Follow-Up of the Child Health and Development Studies Pregnancy Cohort
Background—Few studies have investigated the combination of pregnancy complications that predict risk for cardiovascular disease (CVD) death and how risk changes with age. This report presents a comprehensive investigation of the relation of the occurrence of multiple pregnancy complications to CVD death over 5 decades in a large pregnancy cohort.
Methods and Results—We examined pregnancy events (1959-1967) and CVD death through 2011 in 14,062 women from the Child Health and Development Studies. CVD death was determined by linkage to California Vital Statistics and National Death Index. Women were a median age of 26 years at enrollment and 66 years in 2011. Pre-existing hypertension (Hazard Ratio, (HR)=3.5; 95% Confidence Interval (CI)=2.4,5.1); glycosuria (HR=4.2; CI=1.3,13.1); late-onset pre-eclampsia (after week 34, HR=2.0; CI=1.2,3.5); and hemoglobin decline over the 2nd and 3rd trimesters (HR=1.7; CI=1.2,2.7) predicted CVD death. Delivery of a small-for-gestation or preterm infant and early-onset pre-eclampsia (by week 34) significantly predicted premature CVD death (p<0.05 for age dependence). Preterm birth combined with hemorrhage, gestational hypertension, or pre-existing hypertension identified women with a 4 to 7-fold increased risk of CVD death. Pre-eclampsia in combination with pre-existing hypertension conferred a significant nearly 6-fold risk compared to a 4-fold risk for pre-existing hypertension alone.
Conclusions—We observed combinations of pregnancy complications that predict high risk of death and two new risk markers, glycosuria and hemoglobin decline. Obstetricians serve as primary care physicians for many young women and can readily use these complications to identify high-risk women to implement early prevention.
- cohort study
- hypertension, high blood pressure
- cardiovascular disease risk factors
- Received December 23, 2013.
- Revision received June 25, 2015.
- Accepted July 20, 2015.