Physicians' Academy for Cardiovascular Education

History of adverse pregnancy outcomes associated with subclinical CAD at later age

Association Between History of Adverse Pregnancy Outcomes and Coronary Artery Disease Assessed by Coronary Computed Tomography Angiography

Literature - Sederholm Lawesson S, Swahn S, Pihlsgård M, et al. - JAMA. 2023 Feb 7;329(5):393-404. doi: 10.1001/jama.2022.24093

Introduction and methods


Women with adverse pregnancy outcomes, such as preeclampsia, gestational hypertension, or preterm delivery, have a higher risk of coronary artery disease (CAD) compared with women without these complications [1-8]. However, the association between pregnancy history and CAD is not yet fully understood.

Aim of the study

The study aim was to assess the association between history of adverse pregnancy outcomes and subclinical CAD assessed by coronary computed tomography angiography (CCTA) screening.


This was a prospective cross-sectional study of a Swedish population-based cohort of 10,528 women for whom 1 or more deliveries in 1973 or later were registered in the Swedish National Medical Birth Register and who participated in the Swedish Cardiopulmonary Bioimage Study at age 50–65 years. Median time between the first registered delivery and the CCTA screening was 29.6 years (IQR: 25.0–34.9). Assessed adverse pregnancy outcomes included preeclampsia, gestational hypertension, preterm delivery, small-for-gestational-age infant, and gestational diabetes.


The following 5 complementary coronary atherosclerosis indices were used: any coronary atherosclerosis, any significant stenosis, any noncalcified plaque, segment involvement score of ≥4 (which indicates elevated risk of CV events), and coronary artery calcium score >100 Agatston units.

Main results

Main study cohort

Subgroup analysis


In this population-based cohort of Swedish women aged 50–65 years undergoing CCTA screening, there was a significant association between a history of adverse pregnancy outcomes—especially previous preeclampsia or gestational hypertension—and CCTA-identified CAD. This association was also observed in women who were estimated to have a low CVD risk.


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Find this article online at JAMA.

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