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
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 study cohort
- In total, 1991 women (18.9%) had a history of any adverse pregnancy outcome, ranging from preterm delivery (9.5%) to gestational diabetes (1.4%).
- The prevalence of any coronary atherosclerosis was higher in women with a history of any adverse pregnancy outcome (32.1%; 95%CI: 30.0%–34.2%) compared with women with no such history (28.3%; 95%CI: 27.3%–29.2%) (prevalence difference: 3.8%; 95%CI: 1.6%–6.1%; prevalence ratio: 1.14; 95%CI: 1.06–1.22).
- The prevalence ratios of the other 4 coronary atherosclerosis outcome indices were also significantly higher in women with a history of any adverse pregnancy outcome than those in the reference group.
- Both previous preeclampsia and history of gestational hypertension were significantly associated with higher prevalences of all 5 outcome indices.
- For example, for women with previous preeclampsia, the highest prevalence difference was observed for any coronary atherosclerosis (prevalence difference: 8.0%; 95%CI: 3.7%–12.3%; prevalence ratio: 1.28; 95%CI: 1.14–1.45), while the highest prevalence ratio was found for any significant stenosis (prevalence difference: 3.1%; 95%CI: 1.1%–5.1%; prevalence ratio: 2.46; 95%CI: 1.65–3.67).
- Women with a previous preterm delivery, a small-for-gestational-age infant, or gestational diabetes also showed significantly higher prevalences of several indices, although these prevalences were numerically lower than those in women with previous preeclampsia or gestational hypertension.
- In multivariable-adjusted models, the OR in women with previous preeclampsia ranged from 1.31 (95%CI: 1.07–1.61) for any coronary atherosclerosis to 2.21 (95%CI: 1.42–3.44) for any significant stenosis.
- In a subgroup analysis of 8334 women with low estimated 10-year CVD risk (<5%), history of any adverse pregnancy outcome was associated with significantly higher prevalences of all 5 indices compared with women with no such history. For example, the prevalence difference for any coronary atherosclerosis was 3.2% (95%CI: 0.8%–5.7%; prevalence ratio: 1.14; 95%CI: 1.03–1.24).
- Moreover, previous preeclampsia and gestational hypertension were both significantly associated with higher prevalence ratios of all indices, except for the association between gestational hypertension and any significant stenosis.
- For the other adverse pregnancy outcomes, the prevalence ratios were not significantly higher
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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