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68: Obesity in pregnancy: what’s next? Long-term cardiovascular morbidity in a follow-up period of more than a decade

      Objective

      To investigate whether obesity in pregnancy is an independent risk factor for subsequent long-term cardiovascular morbidity during a follow-up period of more than a decade.

      Study Design

      Data were analyzed from consecutive pregnant women who delivered between 1988 and 1999, and were followed-up retrospectively until 2010. Long-term cardiovascular morbidity was compared among women with and without obesity in pregnancy (defined as maternal pre-pregnancy body mass index (BMI) of 30 kg/m2 or more). Cardiovascular morbidity was divided into four categories including simple and complex cardiovascular events and invasive and noninvasive cardiac procedures. Kaplan-Meier survival curves were used to compare cumulative incidence of cardiovascular hospitalizations. Cox proportional hazards models were used to estimate the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for long term cardiovascular hospitalizations.

      Results

      During the study period 46,688 women met the inclusion criteria; 1221 (2.6%) suffered from obesity during pregnancy. During a follow up period of more than ten years, patients with obesity had higher risk for cardiovascular hospitalizations (Kaplan-Meier survival analysis, P<0.001; Figure). Specifically, obese patients had higher rates of simple cardiovascular events and non-invasive procedures (Table). These complications tended to occur at a younger age (mean 4871±950 days vs. 5060±1140 days from their pregnancy; p=0.001). In a Cox proportional hazards model, adjusted for diabetes mellitus, preeclampsia and maternal age, obesity was independently associated with long-term cardiovascular hospitalizations (adjusted HR 1.33, 95% CI 1.17-1.5).

      Conclusion

      Obesity during pregnancy is an independent risk factor for long-term cardiovascular morbidity, and these complications tend to occur at a younger age. Obese parturients might benefit from cardiovascular risk screening that could lead to early detection and secondary prevention of cardiovascular morbidity.
      Figure thumbnail fx1
      Kaplan-Meier hazard function analysis curve for cardiovascular associated hospitalization of patients with and without obesity
      Tabled 1Cardiovascular hospitalizations in patients with and without obesity
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