Adverse Pregnancy Outcomes Could Predict ASCVD Later in Life

An analysis of data from a major women’s health study is detailing associations between adverse pregnancy outcomes and risk of atherosclerotic cardiovascular disease (ASCVD) in postmenopausal women.

Results of the study, which included information from more than 45k women, suggest adverse pregnancy outcomes were a sex-specific risk factor for ASCVD in women.

With a renewed emphasis on identifying sex-specific risk factors for ASCVD in women, a team of investigators from the University of California San Francisco (UCSF) School of Medicine sought to determine whether adverse pregnancy outcomes could serve as a predictor for ASCVD in these patients. To do so, they designed their study in hopes of using data from the Women’s Health Initiative (WHI) in a retrospective analysis.

From the WHI, investigators obtained data related to a cohort of 48,113 participants. Of note, all women included in WHI were between the ages of 50-79 years when enrolled, were [postmenopausal, and represented ethnically diverse populations. All women included in the current analysis participated in a 2017 questionnaire that surveyed dental health, memory, mental function, and asked specific questions related to history of adverse pregnancy outcomes.

The adverse pregnancy outcomes of interest for the study included gestational diabetes, hypertensive disorders of pregnancy, low birth weight, high birth weight, and preterm delivery by 3 weeks or more. For the purpose of the analysis, the primary outcome was ASCVD, which was defined as myocardial infarction, stroke, peripheral artery disease, or coronary revascularization. Of note, these outcomes were prospectively ascertained and adjudicated using standard criteria.

The median age at time of enrollment for the current study cohort was 60 (55-64.0) years, 28.8% of participants reported 1 or more adverse pregnancy outcome, and about a third of these patients experienced 2 or more adverse pregnancy outcomes.

Upon analysis, investigators found ASCVD was more common in women who reported an adverse pregnancy outcome compared to those without adverse pregnancy outcome (7.6% vs 5.8%). When analyzed separately, investigators determined each of the 5 adverse pregnancy outcomes of interest were significantly associated with ASCVD. When adjusting for ASCVD risk factors, including hyperlipidemia, diabetes, and smoking status, results indicated associations between ASCVD and gestational diabetes, hypertensive disorders of pregnancy, low birth weight, and preterm delivery remained significant.

In analyses examining all 5 adverse pregnancy outcomes of interest jointly for their associations with ASCVD, results indicated only hypertensive disorders of pregnancy (OR, 1.34; 95% CI, 1.15-1.54) and low birth weight (OR, 1.18; 95% CI, 1.03-1.35) were independently associated with ASCVD.

In an invited commentary, a trio of physicians from Barbra Streisand Women's Heart Center at Cedars-Sinai Smidt Heart Institute in Los Angeles discuss how the role of women’s health knowledge needs to transition from the duty of specialists in obstetrics and gynecology to a responsibility for specialists in other fields.

“This new study appears to be the largest that adjusts not only for known ASCVD risk factors but also other APOs and finds independent associations between hypertensive disorders of pregnancy and low birth weight with late ASCVD. Other strengths include the use of a large and multiethnic cohort. Furthermore, the new study includes the adjudication of APOs, while many large cohort studies are limited by the use of self-report APO adjudication, which has low to moderate sensitivity in older women,” wrote the commentary authors.

This study, “Association of Adverse Pregnancy Outcomes With Risk of Atherosclerotic Cardiovascular Disease in Postmenopausal Women,” was published in JAMA Cardiology.