Physicians' Academy for Cardiovascular Education

Preterm delivery is a maternal risk factor of CVD

Preterm delivery and maternal cardiovascular disease in young and middle-aged adult women

Literature - Tanz LJ, Stuart JJ, Williams PL, et al. - Circulation 2017;135:578-589


In the United States ~10% of the deliveries are preterm [1]. It has been hypothesized that pregnancy complications, including preterm delivery, as well as HDP (preeclampsia and gestational hypertension), provide a warning sign of future cardiovascular disease (CVD) risk, that could be useful in identifying high-risk women early in adult life before the appearance of clinical risk factors [2-4]. Prior literature describes a 2-fold increased risk of future CVD events for women who delivered preterm, however, in these studies was not corrected for CVD risk factors and prepregnancy lifestyle such as smoking, physical activity, diet, BMI and family history of CVD [5-7].

Therefore, this study (Nurses’ Health Study II), including 70 182 US registered nurses between 25 and 42 years of age at baseline, evaluated the association between preterm delivery and CVD (myocardial infarction [MI] or stroke) and to what extent this is related to postpartum development of traditional CVD risk factors (chronic hypertension, hypercholesterolemia, type 2 diabetes mellitus [T2DM] and BMI). Preterm delivery was categorized as term (≥37 weeks), moderate preterm (≥32 and <37 weeks) or very preterm (<32 weeks). Follow up was until 50 years of age and started in 1989.

Main results


Women who deliver a preterm infant have an increased risk of future CVD events, which was higher for those who deliver before week 32. This risk is only partially explained by the subsequent development of traditional CVD risk factors, but this suggests that modification of these risk factors in these women may decrease the risk of CVD development. As a large part could not be explained by risk factors, additional pathways that link preterm delivery and CVD need to be further explored. Moreover, preterm delivery may be a valuable additional CVD risk marker in screening.


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