Introduction:
Cardiovascular disease (CVD) is the leading cause of death among women. In stark contrast to mortality declines in other groups, CVD deaths to young women are increasing. CVD prediction in this group is imprecise, and how adverse pregnancy outcomes (APO) may unmask risk during the reproductive years is unknown.
Hypothesis:
Women with APO will have higher 10-year predicted CVD risk within 7 years following a first pregnancy compared to women with no APO.
Study design:
We enrolled 10,038 women at 8 sites in their first pregnancy and followed 4,500 through a CVD visit 2-7 years later. Presented here are results for the first 2,705 with lab results and no hypertension or diabetes before pregnancy. The Atherosclerotic CVD (ASCVD), American Health Association Healthy Heart, Pathobiological Determinants of Atherosclerosis in Youth (PDAY), and Reynolds risk scores were compared in women with preterm birth (PTB), preeclampsia/gestational hypertension (PE/GH), gestational diabetes (GDM), small for gestational age (SGA), and no adverse outcomes (no APO, referent).
Results:
As expected, 10-year predicted CVD risk was very low in women at a median age of 30, although differences at the tail of the distribution were detected based on APO history. Women with no APO had the lowest CVD risk. Women with PTB, PE/GH, GDM, or SGA had higher 10-year CVD risk as predicted by the ASCVD score compared to women with no APO (p<0.05 for PTB and PE/GH). Six to 10% of women with these APOs had ASCVD scores greater than 5%. The PDAY score that predicts risk of coronary artery calcification in young adults was also higher in women with PE/GH or GDM than in those with no APO. Risk factors perturbed after delivery in women with APOs were blood pressure, BMI, waist circumference, HDL-cholesterol, triglycerides, glucose, and HbA1c.
Conclusion:
While risk scores customized for women of reproductive age are needed, those with a first pregnancy complicated by PTB, PE/GH or GDM have modest but detectable predicted 10-year CVD risk as soon as 2-7 years after delivery.
Primary Care–Based Cardiovascular Disease Risk Management After Adverse Pregnancy Outcomes: a Narrative Review
