Preterm delivery has been linked to future maternal cardiovascular disease (CVD); however, research investigating clinical CVD risk factors is limited. We evaluated whether women who have delivered an infant preterm are at higher risk of developing CVD risk factors after adjustment for prepregnancy confounders.
Materials and Methods:
We examined the association between preterm delivery and incident chronic hypertension, type 2 diabetes mellitus (T2DM), and hypercholesterolemia among 57,904 parous women in the Nurses' Health Study II. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between preterm delivery in first pregnancy and each CVD risk factor; adjusted cumulative incidence curves were computed using the Breslow estimator.
Results:
Preterm delivery (<37 weeks) was associated with HRs of 1.11 (95% CI: 1.06–1.17) for chronic hypertension, 1.17 (95% CI: 1.03–1.33) for T2DM, and 1.07 (95% CI: 1.03–1.11) for hypercholesterolemia, adjusting for age, race/ethnicity, parental education, and prepregnancy confounders (e.g., body mass index, smoking, and family history). HRs were higher in women who delivered very preterm (<32 weeks) and in the first 10 years after first birth. The cumulative incidence of each risk factor was highest in women who delivered very preterm.
Conclusions:
Women with a history of preterm delivery are at higher risk of developing chronic hypertension, T2DM, and hypercholesterolemia in the years after pregnancy. This increased risk was particularly pronounced in the first 10 years after a preterm delivery, indicating that it may be an important time period to implement lifestyle interventions.
Get full access to this article
View all access options for this article.
References
1.
BenjaminEJ, ViraniSS, CallawayCW, et al.Heart disease and stroke statistics-2018 update: A report from the American Heart Association. Circulation, 2018; 137:e67–e492.
2.
SattarN, GreerIA. Pregnancy complications and maternal cardiovascular risk: Opportunities for intervention and screening?. BMJ, 2002; 325:157–160.
3.
Rich-EdwardsJW, McElrathTF, KarumanchiSA, SeelyEW. Breathing life into the lifecourse approach: Pregnancy history and cardiovascular disease in women. Hypertension, 2010; 56:331–334.
4.
Rich-EdwardsJW. Reproductive health as a sentinel of chronic disease in women. Womens Health (Lond), 2009; 5:101–105.
5.
BushnellC, McCulloughLD, AwadIA, et al.Guidelines for the prevention of stroke in women: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2014; 45:1545–1588.
6.
MoscaL, BenjaminEJ, BerraK, et al.Effectiveness-based guidelines for the prevention of cardiovascular disease in women—2011 update: A guideline from the American Heart Association. J Am Coll Cardiol, 2011; 57:1404–1423.
7.
SibaiBM. Preeclampsia as a cause of preterm and late preterm (near-term) births. Semin Perinatol, 2006; 30:16–19.
8.
IrgensHU, ReisaeterL, IrgensLM, LieRT. Long term mortality of mothers and fathers after pre-eclampsia: Population based cohort study. BMJ, 2001; 323:1213–1217.
9.
CatovJM, WuCS, OlsenJ, Sutton-TyrrellK, LiJ, NohrEA. Early or recurrent preterm birth and maternal cardiovascular disease risk. Ann Epidemiol, 2010; 20:604–609.
10.
TanzLJ, StuartJJ, WilliamsPL, et al.Preterm delivery and maternal cardiovascular disease in young and middle-aged adult women. Circulation, 2017; 135:578–589.
11.
MartinJA, HamiltonBE, OstermanMJ, DriscollAK, MathewsTJ. Births: Final data for 2015. Natl Vital Stat Rep, 2017; 66:1.
12.
SmithGCS, PellJP, WalshD. Pregnancy complications and maternal risk of ischaemic heart disease: A retrospective cohort study of 129,290 births. Lancet, 2001; 357:2002–2006.
13.
PellJP, SmithGC, WalshD. Pregnancy complications and subsequent maternal cerebrovascular events: A retrospective cohort study of 119,668 births. Am J Epidemiol, 2004; 159:336–342.
14.
BonamyAK, ParikhNI, CnattingiusS, LudvigssonJF, IngelssonE. Birth characteristics and subsequent risks of maternal cardiovascular disease: Effects of gestational age and fetal growth. Circulation, 2011; 124:2839–2846.
15.
HastieCE, SmithGC, MackayDF, PellJP. Maternal risk of ischaemic heart disease following elective and spontaneous pre-term delivery: Retrospective cohort study of 750,350 singleton pregnancies. Int J Epidemiol, 2011; 40:914–919.
16.
KessousR, Shoham-VardiI, ParienteG, HolcbergG, SheinerE. An association between preterm delivery and long-term maternal cardiovascular morbidity. Am J Obstet Gynecol, 2013; 209:368.e1–368.e8.
17.
Rich-EdwardsJW, KlungsoyrK, WilcoxAJ, SkjaervenR. Duration of pregnancy, even at term, predicts long-term risk of coronary heart disease and stroke mortality in women: A population-based study. Am J Obstet Gynecol, 2015; 213:518.e1–518.e8.
18.
LykkeJA, PaidasMJ, DammP, TricheEW, KuczynskiE, Langhoff-RoosJ. Preterm delivery and risk of subsequent cardiovascular morbidity and type-II diabetes in the mother. BJOG, 2010; 117:274–281.
19.
CatovJM, DodgeR, YamalJM, RobertsJM, PillerLB, NessRB. Prior preterm or small-for-gestational-age birth related to maternal metabolic syndrome. Obstet Gynecol, 2011; 117:225–232.
20.
James-ToddT, WiseL, BoggsD, Rich-EdwardsJ, RosenbergL, PalmerJ. Preterm birth and subsequent risk of type 2 diabetes in black women. Epidemiology, 2014; 25:805–810.
21.
James-ToddTM, KarumanchiSA, HibertEL, et al.Gestational age, infant birth weight, and subsequent risk of type 2 diabetes in mothers: Nurses' health study II. Prev Chronic Dis, 2013; 10:E156.
22.
CatovJM, DodgeR, Barinas-MitchellE, et al.Prior preterm birth and maternal subclinical cardiovascular disease 4 to 12 years after pregnancy. J Womens Health (Larchmt), 2013; 22:835–843.
23.
CatovJM, LewisCE, LeeM, WellonsMF, GundersonEP. Preterm birth and future maternal blood pressure, inflammation, and intimal-medial thickness: The CARDIA study. Hypertension, 2013; 61:641–646.
24.
FraserA, NelsonSM, Macdonald-WallisC, et al.Associations of pregnancy complications with calculated cardiovascular disease risk and cardiovascular risk factors in middle age: The Avon longitudinal study of parents and children. Circulation, 2012; 125:1367–1380.
25.
PerngW, StuartJ, Rifas-ShimanSL, Rich-EdwardsJW, StuebeA, OkenE. Preterm birth and long-term maternal cardiovascular health. Ann Epidemiol, 2015; 25:40–45.
26.
ACOG. Practice bulletin no. 102: Management of stillbirth. Obstet Gynecol, 2009; 113:748–761.
27.
FormanJP, CurhanGC, TaylorEN. Plasma 25-hydroxyvitamin D levels and risk of incident hypertension among young women. Hypertension, 2008; 52:828–832.
28.
Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. National Diabetes Data Group. Diabetes, 1979; 28:1039–1057.
29.
Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care, 1997; 20:1183–1197.
30.
MansonJE, RimmEB, StampferMJ, et al.Physical activity and incidence of non-insulin-dependent diabetes mellitus in women. Lancet, 1991; 338:774–778.
31.
ColditzGA, MartinP, StampferMJ, et al.Validation of questionnaire information on risk factors and disease outcomes in a prospective cohort study of women. Am J Epidemiol, 1986; 123:894–900.
32.
SpongCY, MercerBM, D'AltonM, KilpatrickS, BlackwellS, SaadeG. Timing of indicated late-preterm and early-term birth. Obstet Gynecol, 2011; 118:323–333.
33.
BellamyL, CasasJP, HingoraniAD, WilliamsDJ. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: Systematic review and meta-analysis. BMJ, 2007; 335:974.
34.
BrownMC, BestKE, PearceMS, WaughJ, RobsonSC, BellR. Cardiovascular disease risk in women with pre-eclampsia: Systematic review and meta-analysis. Eur J Epidemiol, 2013; 28:1–19.
35.
McDonaldSD, MalinowskiA, ZhouQ, YusufS, DevereauxPJ. Cardiovascular sequelae of preeclampsia/eclampsia: A systematic review and meta-analyses. Am Heart J, 2008; 156:918–930.
36.
WuP, HaththotuwaR, KwokCS, et al.Preeclampsia and future cardiovascular health: A systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes, 2017; 10:pii:e003497.
37.
HeidaKY, FranxA, van RijnBB, et al.Earlier age of onset of chronic hypertension and type 2 diabetes mellitus after a hypertensive disorder of pregnancy or gestational diabetes mellitus. Hypertension, 2015; 66:1116–1122.
38.
MannistoT, MendolaP, VaarasmakiM, et al.Elevated blood pressure in pregnancy and subsequent chronic disease risk. Circulation, 2013; 127:681–690.
39.
LykkeJA, Langhoff-RoosJ, SibaiBM, FunaiEF, TricheEW, PaidasMJ. Hypertensive pregnancy disorders and subsequent cardiovascular morbidity and type 2 diabetes mellitus in the mother. Hypertension, 2009; 53:944–951.
40.
MagnussenEB, VattenLJ, SmithGD, RomundstadPR. Hypertensive disorders in pregnancy and subsequently measured cardiovascular risk factors. Obstet Gynecol, 2009; 114:961–970.
41.
FeigDS, ShahBR, LipscombeLL, et al.Preeclampsia as a risk factor for diabetes: A population-based cohort study. PLoS Med, 2013; 10:e1001425.
42.
DrostJT, ArpaciG, OttervangerJP, et al.Cardiovascular risk factors in women 10 years post early preeclampsia: The Preeclampsia Risk EValuation in FEMales study (PREVFEM). Eur J Prev Cardiol, 2012; 19:1138–1144.
43.
MarinR, GorostidiM, PortalCG, SanchezM, SanchezE, AlvarezJ. Long-term prognosis of hypertension in pregnancy. Hypertens Pregnancy, 2000; 19:199–209.
44.
WilsonBJ, WatsonMS, PrescottGJ, et al.Hypertensive diseases of pregnancy and risk of hypertension and stroke in later life: Results from cohort study. BMJ, 2003; 326:845.
45.
KaulP, SavuA, NerenbergKA, et al.Impact of gestational diabetes mellitus and high maternal weight on the development of diabetes, hypertension and cardiovascular disease: A population-level analysis. Diabet Med, 2015; 32:164–173.
46.
CarrDB, UtzschneiderKM, HullRL, et al.Gestational diabetes mellitus increases the risk of cardiovascular disease in women with a family history of type 2 diabetes. Diabetes Care, 2006; 29:2078–2083.
47.
ShahBR, RetnakaranR, BoothGL. Increased risk of cardiovascular disease in young women following gestational diabetes mellitus. Diabetes Care, 2008; 31:1668–1669.
48.
TobiasDK, HuFB, FormanJP, ChavarroJ, ZhangC. Increased risk of hypertension after gestational diabetes mellitus: Findings from a large prospective cohort study. Diabetes Care, 2011; 34:1582–1584.
49.
JulienM, HanleyJA. Profile-specific survival estimates: Making reports of clinical trials more patient-relevant. Clin Trials, 2008; 5:107–115.
50.
GoldenbergRL, CulhaneJF, IamsJD, RomeroR. Epidemiology and causes of preterm birth. Lancet, 2008; 371:75–84.
51.
American Diabetes Association. Economic Costs of Diabetes in the U.S. in 2017. Diabetes Care, 2018; 41:917–928.
ZelnickLR, WeissNS, KestenbaumBR, et al.Diabetes and CKD in the United States Population, 2009–2014. Clin J Am Soc Nephrol, 2017; 12:1984–1990.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
