Prenatal biochemical screening and long term risk of maternal cardiovascular disease: population based cohort study

Abstract

ObjectiveTo examine whether abnormal prenatal biochemical screening results are associated with an increased risk of premature cardiovascular disease after pregnancy.DesignPopulation based cohort study.SettingThe entire province of Ontario, Canada, where healthcare is universally available.ParticipantsWomen aged 12-55 years, without pre-existing cardiovascular disease, who underwent prenatal screening between 1993 and 2011. One pregnancy per woman was randomly selected.ExposuresLow (≤5th centile multiple of the median) serum total chorionic gonadotropin, unconjugated estriol, and pregnancy associated plasma protein A and high (≥95th centile multiple of the median) alphafetoprotein and dimeric inhibin-A.Main outcome measuresComposite of hospital admission or revascularisation for coronary artery, cerebrovascular, or peripheral arterial disease or hospital admission for heart failure or dysrhythmia at least 365 days after pregnancy.ResultsAmong 855 536 pregnancies, and after a median of 11.4 (interquartile range 6.8-17.5) years of follow-up, 6209 women developed the main cardiovascular disease outcome. Abnormal results for each of the five prenatal biochemical screening analytes, especially dimeric inhibin-A, were associated with a higher risk of cardiovascular disease. Women with an abnormally high dimeric inhibin-A (≥95th centile) had the highest rate of cardiovascular disease (30 events or 8.3 per 10 000 person years versus 251 events or 3.8 per 10 000 person years for those <95th centile; multivariable adjusted hazard ratio 2.0, 95% confidence interval 1.4 to 3.0). Compared with women without any abnormal biochemical measure, the hazard ratio for the cardiovascular disease composite outcome was 1.2-1.3 times higher with one abnormal analyte and 1.5-2.0 times higher with two or more abnormal analytes.ConclusionsWomen with abnormal prenatal biochemical screening results, especially for dimeric inhibin-A, may be at higher risk of cardiovascular disease. If these findings are replicated elsewhere, a massive amount of data exists that could aid in identifying women at higher risk of premature cardiovascular disease and that could be conveyed to them or their healthcare providers.

Exploring Fetal Sex as a Risk Factor for Sleep Disordered Breathing and Its Complications in Pregnancy

“…Several studies have demonstrated that pregnant women carrying a female fetus, in the absence of chromosomal abnormalities, have higher levels of free b-hCG and pregnancy-associated plasma protein A (PAPP-A). [21][22][23] It is also known that having low first trimester PAPP-A values is associated with increased risk of obstetric complications, such as preeclampsia and maternal long-term cardiovascular diseases, 36,37 and our own data have shown lower levels of PAPP-A in women with SDB compared to controls. 38…”

Inhibin as a reproductive biomarker part 2. Clinical significance of inhibins in reproductive medicine

“…Первоначально пренатальный биохимический скрининг у беременных применяли только для диагностики аномалий развития у плода. Однако впоследствии было установлено, что он обладает высокой специфичностью для ранней диагностики высокого риска преэклампсии, а также для оценки долгосрочного риска возникновения тяжелых сердечно-сосудистых заболеваний у женщин [54][55][56]. Было установлено, что чем выше уровни АФП, ХГЧ и ингибина, тем больше вероятность развития преэклампсии и возникновения в будущем сердечно-сосудистой патологии.…”