Pregnancy complications in last pregnancy and mothers’ long-term cardiovascular mortality: does the relation differ from that of complications in first pregnancy? A population-based study

Abstract

Background Women who experience complications in first pregnancy are at increased risk of cardiovascular disease (CVD) later in life. Little corresponding knowledge is available for complications in later pregnancies. Therefore, we assessed complications (preeclampsia, preterm birth, and offspring small for gestational age) in first and last pregnancies and the risk of long-term maternal CVD death, taking women´s complete reproduction into account. Data and methods We linked data from the Medical Birth Registry of Norway to the national Cause of Death Registry. We followed women whose first birth took place during 1967–2013, from the date of their last birth until death, or December 31st 2020, whichever occurred first. We analysed risk of CVD death until 69 years of age according to any complications in last pregnancy. Using Cox regression analysis, we adjusted for maternal age at first birth and level of education. Results Women with any complications in their last or first pregnancy were at higher risk of CVD death than mothers with two-lifetime births and no pregnancy complications (reference). For example, the adjusted hazard ratio (aHR) for women with four births and any complications only in the last pregnancy was 2.85 (95% CI, 1.93–4.20). If a complication occurred in the first pregnancy only, the aHR was 1.74 (1.24–2.45). Corresponding hazard ratios for women with two births were 1.82 (CI, 1.59–2.08) and 1.41 (1.26–1.58), respectively. Conclusions The risk for CVD death was higher among mothers with complications only in their last pregnancy compared to women with no complications, and also higher compared to mothers with a complication only in their first pregnancy.

Harnessing women's full reproductive history in assessing cardiovascular risk

“…We have recently shown that complications in the last pregnancy are associated with a stronger burden of CVD deaths than complications in the 1st pregnancy. 5 4. In addition to one-child mothers, the risk should be evaluated in other subgroups of women.…”

“…4 Furthermore, the order in which preeclampsia occurs in a woman's reproductive history matters. 5 Pregnancy complications in one pregnancy may be linked to other complications in a subsequent pregnancy, even complications at term. By using a woman's complete pregnancy history, it is possible to evaluate the association between preeclampsia and long-term CVD mortality by the pattern of occurrence of HDP, 6 as well as other complications, in later pregnancies.…”

Preterm birth, preeclampsia, gestational hypertension and offspring birth weight in women with active juvenile idiopathic arthritis and healthy controls

“…Both SGA and large for gestational age (LGA) are being discussed as risk factors for the growing child and adult life (10). There is increasing evidence that preterm birth, preeclampsia, and abnormal fetal growth increase the risk for maternal cardiovascular disease later in life (11).…”