Association of Spontaneous Preterm Delivery and Future Maternal Cardiovascular Disease

Minissian, Margo; Kilpatrick, Sarah J.; Eastwood, Jo‐Ann; Robbins, Wendie A.; Accortt, Eynav Elgavish; Wei, Janet; Shufelt, Chrisandra; Doering, Lynn V.; Merz, C. Noel Bairey

doi:10.1161/circulationaha.117.031403

Cited by 44 publications

(27 citation statements)

References 50 publications

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“…PTB not only poses risk to the child, but it may also identify women with elevated lifetime risk for CVD (96). Indeed, women with PTB are more likely to have CV events and increased hospitalization rates (97) Robbins et al reported a significant increase in the incidence of AMI, stroke and CAD in these women (98). Compared with normal term delivery, spontaneous preterm delivery (sPTD) has been…”

Section: Preterm Birthmentioning

confidence: 99%

Women-specific predictors of cardiovascular disease risk - new paradigms

Maffei

Guiducci

Cugusi

et al. 2019

International Journal of Cardiology

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Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality in women in spite of the overall reduction in age-adjusted CVD mortality in the past few years. Although traditional risk factors for CVD are predictors of increased risk in both men and women, risk factors that are unique to women and related to their reproductive history have recently been considered to be important. The development of CVD in women may correlate with specific events taking place throughout a woman's obstetric and gynaecological history. Gynaecological conditions such as polycystic ovary syndrome, premature ovarian failure, surgical and spontaneous menopause, and conditions related to pregnancy, i.e. gestational diabetes, preeclampsia, intrauterine growth restriction, miscarriages, and preterm birth, may affect the onset, clinical features, and prognosis of CVD later in women's lives. These pathological conditions that develop during the fertile period of life or peri-menopause have been suggested to be early markers of future CVD; their presence presents a unique opportunity for the early identification of women who may be at an increased risk of CVD. The assessment of CV risk in women should not just focus on conventional risk factors but also on different aspects of the gynaecological history to allow specific preventive and therapeutic strategies to be established. This paper reviews the various pathological conditions occurring in women during their fertile period of life and peri-menopause, which have been identified to potentially increase CVD risk.

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Section: Preterm Birthmentioning

confidence: 99%

Women-specific predictors of cardiovascular disease risk - new paradigms

Maffei

Guiducci

Cugusi

et al. 2019

International Journal of Cardiology

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“…All-cause PTDs are associated with a 1.5-to 3-fold higher risk of CVD [1][2][3][4]6]. Previous studies have shown that much of this association is accounted for by metabolic disorders during pregnancy, especially preeclampsia (which explains about 24-26% of the association) [1], or by metabolic disorders postpartum (which may explain about 13-15% of the association) [3]; however, a substantial portion of the risk remains unaccounted for.…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have shown that much of this association is accounted for by metabolic disorders during pregnancy, especially preeclampsia (which explains about 24-26% of the association) [1], or by metabolic disorders postpartum (which may explain about 13-15% of the association) [3]; however, a substantial portion of the risk remains unaccounted for. The PTD-CVD associations persist even in pregnancies uncomplicated by preeclampsia or hypertensive disorders [3,6,7], indicating the need to explore other pathways via which PTD and CVD are linked. PTD is heterogeneous, with a variety of different PTD subtypes (i.e., spontaneous vs. medically indicated PTD), with and without preeclampsia, which may affect CVD risk through different pathways.…”

Section: Introductionmentioning

confidence: 99%

Postpartum plasma metabolomic profile among women with preeclampsia and preterm delivery: implications for long-term health

Hong

Zhang

Liang

et al. 2020

BMC Med

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Background Preeclampsia and preterm delivery (PTD) are believed to affect women’s long-term health including cardiovascular disease (CVD), but the biological underpinnings are largely unknown. We aimed to test whether maternal postpartum metabolomic profiles, especially CVD-related metabolites, varied according to PTD subtypes with and without preeclampsia, in a US urban, low-income multi-ethnic population. Methods This study, from the Boston Birth Cohort, included 980 women with term delivery, 79 with medically indicated PTD (mPTD) and preeclampsia, 52 with mPTD only, and 219 with spontaneous PTD (sPTD). Metabolomic profiling in postpartum plasma was conducted by liquid chromatography-mass spectrometry. Linear regression models were used to assess the associations of each metabolite with mPTD with preeclampsia, mPTD only, and sPTD, respectively, adjusting for pertinent covariates. Weighted gene coexpression network analysis was applied to investigate interconnected metabolites associated with the PTD/preeclampsia subgroups. Bonferroni correction was applied to account for multiple testing. Results A total of 380 known metabolites were analyzed. Compared to term controls, women with mPTD and preeclampsia showed a significant increase in 36 metabolites, mainly representing acylcarnitines and multiple classes of lipids (diacylglycerols, triacylglycerols, phosphocholines, and lysophosphocholines), as well as a decrease in 11 metabolites including nucleotides, steroids, and cholesteryl esters (CEs) (P < 1.3 × 10−4). Alterations of diacylglycerols, triacylglycerols, and CEs in women with mPTD and preeclampsia remained significant when compared to women with mPTD only. In contrast, the metabolite differences between women with mPTD only and term controls were only seen in phosphatidylethanolamine class. Women with sPTD had significantly different levels of 16 metabolites mainly in amino acid, nucleotide, and steroid classes compared to term controls, of which, anthranilic acid, bilirubin, and steroids also had shared associations in women with mPTD and preeclampsia. Conclusion In this sample of US high-risk women, PTD/preeclampsia subgroups each showed some unique and shared associations with maternal postpartum plasma metabolites, including those known to be predictors of future CVD. These findings, if validated, may provide new insight into metabolomic alterations underlying clinically observed PTD/preeclampsia subgroups and implications for women’s future cardiometabolic health.

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“… 7 , 8 Several risk factors related to pregnancy have been identified as affecting younger women. In a review of associations between preterm delivery and future maternal cardiovascular disease, Minissian et al suggested that abnormal responses to pregnancy were a woman's first physiological “stress test.” 9 Veerbeek et al found that 39% of women with pregnancy-induced hypertension continued to have elevated blood pressure in the postpartum period. 10 Gestational diabetes has also been linked to an increased lifetime risk of type 2 diabetes (T2DM), a coronary heart disease equivalent.…”

Section: Introductionmentioning

confidence: 99%

What's the Risk? Older Women Report Fewer Symptoms for Suspected Acute Coronary Syndrome than Younger Women

DeVon

Vuckovic

Burke

et al. 2018

BioResearch Open Access

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The purpose of the study was to determine whether older (≥65 years) and younger (<65 years) women presenting to the emergency department (ED) with symptoms suggestive of acute coronary syndrome (ACS) varied on risk factors, comorbid conditions, functional status, and symptoms that have implications for emergent cardiac care. Women admitted to five EDs were enrolled. The ACS Symptom Checklist was used to measure symptoms. Comorbid conditions and functional status were measured with the Charlson Comorbidity Index and Duke Activity Status Index. Logistic regression models were used to evaluate symptom differences in older and younger women adjusting for ACS diagnosis, functional status, body mass index (BMI), and comorbid conditions. Analyses were stratified by age, and interaction of symptom by age was tested. Four hundred women were enrolled. Mean age was 61.3 years (range 21–98). Older women (n = 163) were more likely to have hypertension, hypercholesterolemia, never smoked, lower BMI, more comorbid conditions, and lower functional status. Younger women (n = 237) were more likely to be members of minority groups, be college-educated, and have a non-ACS discharge diagnosis. Younger women had higher odds of experiencing chest discomfort, chest pain, chest pressure, shortness of breath, nausea, sweating, and palpitations. Lack of chest symptoms and shortness of breath (key symptoms triggering a decision to seek emergency care) may cause older women to delay seeking treatment, placing them at risk for poorer outcomes. Younger African American women may require more comprehensive risk reduction strategies and symptom management.

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Association of Spontaneous Preterm Delivery and Future Maternal Cardiovascular Disease

Cited by 44 publications

References 50 publications

Women-specific predictors of cardiovascular disease risk - new paradigms

Women-specific predictors of cardiovascular disease risk - new paradigms

Postpartum plasma metabolomic profile among women with preeclampsia and preterm delivery: implications for long-term health

What's the Risk? Older Women Report Fewer Symptoms for Suspected Acute Coronary Syndrome than Younger Women

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