Adverse pregnancy outcomes and development of short-term cardiovascular disease risk factors.

BACKGROUND: There are limited data defining the rate of progression of the development of adverse pregnancy outcomes and short-term cardiovascular risk factors in a contemporary cohort. OBJECTIVE: This study aimed to examine the association between adverse pregnancy outcomes and short-term cardiovascular disease risk factors in a contemporary population. STUDY DESIGN: This was a hospital-based electronic health record retrospective cohort study from 2 healthcare systems in North Carolina. Patients who gave birth between 2016 and 2020, were free of cardiovascular disease risk factors or events at delivery, and had >1 prenatal care appointment during pregnancy and 1 postnatal care appointment ≤3 months after delivery were included in the study. However, only the first pregnancy in the study period was included. Adverse pregnancy outcomes were defined using the International Classification of Diseases, 10th Revision, codes for preeclampsia, gestational hypertension, gestational diabetes mellitus, preterm birth, and small-for-gestational-age infant. The development of a short-term cardiovascular disease risk factor was defined as a new diagnosis of chronic hypertension, hyperlipidemia, diabetes mellitus, or prediabetes mellitus by December 31, 2021. Cox proportional hazards regression was used to model associations between adverse pregnancy outcomes and cardiovascular disease risk factors. RESULTS: A total of 32,623 patients were included in this study. More than a quarter of the patients (8965 [27.5%]) experienced at least 1 adverse pregnancy outcome, with more patients with an adverse pregnancy outcome developing a cardiovascular disease risk factor during follow-up than those without an adverse pregnancy outcome (9.5% vs 3.2%, respectively). Patients with any adverse pregnancy outcomes were 3 times more likely to be diagnosed with a cardiovascular disease risk factor (hazard ratio, 3.11 [95% confidence interval, 2.87-3.38]) and had a median time to event of 1.98 years (interquartile range, 0.82-3.34). The highest risks were observed in patients with gestational diabetes mellitus developing type 2 diabetes mellitus (hazard ratio, 21.29 [95% confidence interval, 16.49-27.47]) and in those with preeclampsia developing chronic hypertension (hazard ratio, 6.35 [95% confidence interval, 5.51-7.32]). CONCLUSION: A pregnancy complicated by an adverse pregnancy outcome is associated with a 3-fold increased risk of developing cardiovascular disease risk factors as early as 2 years after delivery. These findings highlight the importance of screening for cardiovascular disease risk factors in the early years after delivery for patients who experienced an adverse pregnancy outcome.

Duke Scholars

Author Ricardo Henao Biostatistics & Bioinformatics, Division of Translational Bi ...