ImportanceAdverse pregnancy outcomes are recognized risk enhancers for cardiovascular disease, but the prevalence of subclinical coronary atherosclerosis after these conditions is unknown.ObjectiveTo assess associations between history of adverse pregnancy outcomes and coronary artery disease assessed by coronary computed tomography angiography screening.Design, Setting, and ParticipantsCross-sectional study of a population-based cohort of women in Sweden (n = 10 528) with 1 or more deliveries in 1973 or later, ascertained via the Swedish National Medical Birth Register, who subsequently participated in the Swedish Cardiopulmonary Bioimage Study at age 50 to 65 (median, 57.3) years in 2013-2018. Delivery data were prospectively collected.ExposuresAdverse pregnancy outcomes, including preeclampsia, gestational hypertension, preterm delivery, small-for-gestational-age infant, and gestational diabetes. The reference category included women with no history of these exposures.Main Outcomes and MeasuresCoronary computed tomography angiography indexes, including any coronary atherosclerosis, significant stenosis, noncalcified plaque, segment involvement score of 4 or greater, and coronary artery calcium score greater than 100.ResultsA median 29.6 (IQR, 25.0-34.9) years after first registered delivery, 18.9% of women had a history of adverse pregnancy outcomes, with specific pregnancy histories ranging from 1.4% (gestational diabetes) to 9.5% (preterm delivery). The prevalence of any coronary atherosclerosis in women with a history of any adverse pregnancy outcome was 32.1% (95% CI, 30.0%-34.2%), which was significantly higher (prevalence difference, 3.8% [95% CI, 1.6%-6.1%]; prevalence ratio, 1.14 [95% CI, 1.06-1.22]) compared with reference women. History of gestational hypertension and preeclampsia were both significantly associated with higher and similar prevalence of all outcome indexes. For preeclampsia, the highest prevalence difference was observed for any coronary atherosclerosis (prevalence difference, 8.0% [95% CI, 3.7%-12.3%]; prevalence ratio, 1.28 [95% CI, 1.14-1.45]), and the highest prevalence ratio was observed for significant stenosis (prevalence difference, 3.1% [95% CI, 1.1%-5.1%]; prevalence ratio, 2.46 [95% CI, 1.65-3.67]). In adjusted models, odds ratios for preeclampsia ranged from 1.31 (95% CI, 1.07-1.61) for any coronary atherosclerosis to 2.21 (95% CI, 1.42-3.44) for significant stenosis. Similar associations were observed for history of preeclampsia or gestational hypertension among women with low predicted cardiovascular risk.Conclusions and RelevanceAmong Swedish women undergoing coronary computed tomography angiography screening, there was a statistically significant association between history of adverse pregnancy outcomes and image-identified coronary artery disease, including among women estimated to be at low cardiovascular disease risk. Further research is needed to understand the clinical importance of these associations.
SYNOPSISAn amphiphilic graft copolymer was prepared by transesterification of poly( 2-ethylhexyl acrylate-co-methyl methacrylate) with poly(ethy1ene glycol) monomethyl ether (MPEG2000). The grafting reaction was performed in melt at 155°C. The purified graft copolymer was blended into poly(methy1 methacrylate) in concentrations of 1.5-30 wt %, either by mixing in chloroform solution or by melt mixing by means of a twin-screw extruder or a Brabender blender. Films of the blends were prepared by solution casting onto glass plates or by hot pressing between polished A1 plates. At concentrations up to 20% of the graft copolymer homogeneous blends were obtained. At higher concentrations the blends were heterogeneous, and side-chain crystallinity was detectable by DSC analysis. The surface properties of the films were studied by measurements of water contact angles. The surface accumulation of the graft copolymer was demonstrated as a large increase in the wetting angle hysteresis, and found to depend on the procedure for film preparation as well as the casting substrate.
Purpose of Review Women with prevalent pregnancy complications (including preterm birth and preeclampsia) have twice the risk of later cardiovascular disease (CVD) compared to unaffected women. Current prevention guidelines recommend that reproductive history should be part of a woman's CVD risk assessment. This review synthesizes recent findings on the value of history of pregnancy complications in 10-year CVD risk prediction. Recent Findings The associations between several pregnancy complications and CVD are still evident when conventional predictors are considered in middle age. However, comprehensive evaluation suggests that these associations translate into only minor, if any, clinically relevant improvements in prediction. Summary Current evidence suggests that 10-year CVD risk prediction in women is not substantially improved by history of pregnancy complications. Future studies should identify subgroups to target with prevention efforts post-pregnancy. In the meantime, conventional models are appropriate for estimating 10-year CVD risk in women with a history of pregnancy complications.
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