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Pregnancy as a window to future health: maternal placental syndromes and short-term cardiovascular outcomes

      Background

      Cardiovascular disease is the leading cause of death among women. Identifying risk factors for future cardiovascular disease may lead to earlier lifestyle modifications and disease prevention. Additionally, interpregnancy development of cardiovascular disease can lead to increased perinatal morbidity in subsequent pregnancies. Identification and implementation of interventions in the short term (within 5 years of first pregnancy) may decrease morbidity in subsequent pregnancies.

      Objective

      We identified the short-term risk (within 5 years of first pregnancy) of cardiovascular disease among women who experienced a maternal placental syndrome, as well as preterm birth and/or delivered a small-for-gestational-age infant.

      Study Design

      We conducted a retrospective cohort study using a population-based, clinically enhanced database of women in the state of Florida. Nulliparous women and girls aged 15-49 years experiencing their first delivery during the study time period with no prepregnancy history of diabetes mellitus, hypertension, or heart or renal disease were included in the study. The risk of subsequent cardiovascular disease was compared among women who did and did not experience a placental syndrome during their first pregnancy. Risk was then reassessed among women with placental syndrome and preterm birth or delivering a small-for-gestational-age infant vs those without these adverse pregnancy outcomes.

      Results

      The final study population was 302,686 women and girls. Median follow-up time for each patient was 4.9 years. The unadjusted rate of subsequent cardiovascular disease among women and girls with any placental syndrome (11.8 per 1000 women) was 39% higher than the rate among women and girls without a placental syndrome (8.5 per 1000 women). Even after adjusting for sociodemographic factors, preexisting conditions, and clinical and behavioral conditions associated with the current pregnancy, women and girls with any placental syndrome experienced a 19% increased risk of cardiovascular disease (hazard ratio, 1.19; 95% confidence interval, 1.07–1.32). Women and girls with >1 placental syndrome had the highest cardiovascular disease risk (hazard ratio, 1.43; 95% confidence interval, 1.20–1.70), followed by those with eclampsia/preeclampsia alone (hazard ratio, 1.42; 95% confidence interval, 1.14–1.76). When placental syndrome was combined with preterm birth and/or small for gestational age, the adjusted risk of cardiovascular disease increased 45% (95% confidence interval, 1.24–1.71). Women and girls with placental syndrome who then developed cardiovascular disease experienced a 5-fold increase in health care–related costs during follow-up, compared to those who did not develop cardiovascular disease.

      Conclusion

      Women and girls experiencing placental syndromes and preterm birth or small-for-gestational-age infant are at increased risk of subsequent cardiovascular disease in short-term follow-up. Strategies to identify and improve cardiovascular disease risk in the postpartum period may improve future heart disease outcomes.

      Key words

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      Linked Article

      • Progressive uterorenal denervation may contribute to both placental and cardiovascular syndromes?
        American Journal of Obstetrics & GynecologyVol. 216Issue 4
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          Cain et al1 find that women experiencing “placental syndromes” are at increased risk of serious cardiovascular disease within 5 years. We believe they have a common source of injury, namely, progressive autonomic denervation. Both uterus and kidneys receive sympathetic nerves from the same thoracic segments (T10-12). Persistent physical efforts during defecation are a common source of progressive autonomic injury in Western populations where they complicate 20-30% of Western bowel movements.2 With the introduction of Western fast foods and removal of squat toilets over the past 25 years, it is becoming a major source of recent, cardiovascular morbidity in China.
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