Association of Adverse Pregnancy Outcomes with Risk of Atherosclerotic Cardiovascular Disease in Postmenopausal Women

Marc Meller Søndergaard, Mark A. Hlatky, Marcia L. Stefanick, Eric Vittinghoff, Gregory Nah, Matthew Allison, Alison Gemmill, Linda Van Horn, Ki Park, Elena Salmoirago-Blotcher, Maryam Sattari, Shawnita Sealy-Jefferson, Aladdin H. Shadyab, Carolina Valdiviezo, Jo Ann E. Manson, Nisha I. Parikh*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Importance: Atherosclerotic cardiovascular disease (ASCVD) may have unique risk factors in women. Most women have a history of pregnancy; common adverse pregnancy outcomes (APOs) appear to be associated with ASCVD, but prior studies have limitations. Objective: To assess whether APOs are associated with increased ASCVD risk independently of traditional risk factors. Design, Setting, and Participants: The APO history among participants in the Women's Health Initiative, a large multiethnic cohort of postmenopausal women, was assessed. The associations of 5 self-reported APOs (gestational diabetes, hypertensive disorders of pregnancy, low birth weight [ie, birth weight less than 2.49 kg], high birth weight [ie, birth weight greater than 4.08 kg], and preterm delivery by 3 weeks or more) with ASCVD were analyzed, adjusting for traditional ASCVD risk factors. Data were collected and analyzed in 2017. Exposures: APOs (gestational diabetes, hypertensive disorders of pregnancy, low birth weight, high birth weight, and preterm delivery). Main Outcomes and Measures: Adjudicated ASCVD. Results: A total of 48113 Women's Health Initiative participants responded to the survey; the median (interquartile range) age at time of enrollment was 60.0 (55.0-64.0) years. A total of 13482 participants (28.8%) reported 1 or more APOs. Atherosclerotic cardiovascular disease was more frequent in women who reported an APO compared with those without APOs (1028 of 13 482 [7.6%] vs 1758 of 30 522 [5.8%]). Each APO, analyzed separately, was significantly associated with ASCVD, and gestational diabetes, hypertensive disorders of pregnancy, low birth weight, and preterm delivery remained significant after adjustment for traditional ASCVD risk factors. When all APOs were analyzed together, hypertensive disorders of pregnancy (odds ratio, 1.27; 95% CI, 1.15-1.40) and low birth weight (odds ratio, 1.12; 95% CI, 1.00-1.26) remained independently associated with ASCVD. All findings were materially unchanged by additional adjustment for parity, body mass index, and socioeconomic factors. Conclusions and Relevance: In this large multiethnic cohort of women, hypertensive disorders of pregnancy and low birth weight were independently associated with ASCVD after adjustment for risk factors and other APOs.

Original languageEnglish (US)
Pages (from-to)1390-1398
Number of pages9
JournalJAMA cardiology
Volume5
Issue number12
DOIs
StatePublished - Dec 2020

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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