Preterm Delivery and Future Risk of Maternal Cardiovascular Disease: A Systematic Review and Meta‐Analysis

Abstract

BackgroundPreterm delivery (<37 weeks gestational age) affects 11% of all pregnancies, but data are conflicting whether preterm birth is associated with long‐term adverse maternal cardiovascular outcomes. We aimed to systematically evaluate and summarize the evidence on the relationship between preterm birth and future maternal risk of cardiovascular diseases.Methods and ResultsA systematic search of MEDLINE and EMBASE was performed to identify relevant studies that evaluated the association between preterm birth and future maternal risk of composite cardiovascular disease, coronary heart disease, stroke, and death caused by cardiovascular or coronary heart disease and stroke. We quantified the associations using random effects meta‐analysis. Twenty‐one studies with over 5.8 million women, including over 338 000 women with previous preterm deliveries, were identified. Meta‐analysis of studies that adjusted for potential confounders showed that preterm birth was associated with an increased risk of maternal future cardiovascular disease (risk ratio [RR] 1.43, 95% confidence interval [CI], 1.18, 1.72), cardiovascular disease death (RR 1.78, 95% CI, 1.42, 2.21), coronary heart disease (RR 1.49, 95% CI, 1.38, 1.60), coronary heart disease death (RR 2.10, 95% CI, 1.87, 2.36), and stroke (RR 1.65, 95% CI, 1.51, 1.79). Sensitivity analysis showed that the highest risks occurred when the preterm deliveries occurred before 32 weeks gestation or were medically indicated.ConclusionsPreterm delivery is associated with an increase in future maternal adverse cardiovascular outcomes, including a 2‐fold increase in deaths caused by coronary heart disease. These findings support the assessment of preterm delivery in cardiovascular risk assessment in women.

FIGO (International Federation of Gynecology and Obstetrics) Postpregnancy Initiative: Long‐term Maternal Implications of Pregnancy Complications—Follow‐up Considerations

“…In the remaining two‐thirds, the onset of labor is spontaneous and impaired placentation has also been implicated as the underlying pathophysiology. A growing body of evidence, synthesized in systematic reviews, has demonstrated that women who deliver preterm, spontaneously or medically‐indicated, are at a greater risk of developing CVD …”

“…The latest systematic review and meta‐analysis of 21 studies including over 5.8 million women (out of whom more than 338 000 women had a history of preterm birth) demonstrated that preterm birth was associated with an increased adjusted risk of future CVD (RR 1.43; 95% CI, 1.18–1.72), CVD mortality (RR 1.78; 95% CI, 1.42–2.21), coronary heart disease (RR 1.49; 95% CI, 1.38–1.60), coronary heart disease mortality (RR 2.10; 95% CI, 1.87–2.36), and stroke (RR 1.65; 95% CI, 1.51–1.79) . Most importantly, the highest risk occurred when preterm birth occurred before 32 weeks of pregnancy or was medically indicated.…”

Pregnancy‐Related Risk Factors Are Associated With a Significant Burden of Treated Hypertension Within 10 Years of Delivery: Findings From a Population‐Based Norwegian Cohort

“…De novo hypertensive disorders of pregnancy and gestational diabetes mellitus (GDM) are recognized as risk factors for premature maternal CVD 2. Evidence has also been accumulating on maternal CVD associated with other pregnancy‐related complications and outcomes,3 such as preterm delivery,4, 5, 6, 7, 8, 9, 10, 11 fetal growth restriction5, 7, 10, 12 placental abruption,13 and pregnancy losses 5, 14, 15, 16…”

Contemporary Issues in Women's Health

“…However, there is some evidence that preterm delivery could be associated with an increased risk of future maternal cardiovascular health. A recent systematic review and meta‐analysis has been published, in which information related to preterm delivery and the risk of maternal cardiovascular disease has been included. The authors included only cohort studies with a low risk of bias and they excluded patients who had had cardiovascular disease before or during pregnancy.…”

“…Sensitivity analyses were performed to consider the effect of pregnancy duration, recurrence, and spontaneous onset of preterm delivery on maternal cardiovascular outcomes. The authors found that the risks were higher when preterm deliveries occurred before 32 weeks of pregnancy or among those deliveries with medical indications such as fetal growth or pre‐eclampsia …”