ArticlesCardiovascular health after maternal placental syndromes (CHAMPS): population-based retrospective cohort study
Introduction
Pre-eclampsia affects 3–5% of all pregnancies and results in hypertension and proteinuria after 20 weeks' gestation. It is associated with abruption or infarction of the placenta, necessitating preterm delivery, and can be further complicated by fetal growth restriction and intrauterine fetal death.1, 2 Though their cause is both multifactorial and elusive, these maternal placental syndromes seem to share some common mechanisms,3 including diseased spiral arteries, placental ischaemia, and endothelial dysfunction.3, 4, 5
Probable maternal risk factors for placental syndromes—obesity,6 insulin resistance,7 dyslipidaemia, and chronic hypertension8, 9—are also independent predictors of adult-onset cardiovascular disease.10, 11 Indeed, women with a history of hypertension in pregnancy are probably at higher risk of cardiovascular disease.12, 13, 14, 15, 16
Our aim was to assess this risk of premature cardiovascular disease in relation to not only the hypertensive diseases of pregnancy, but also to abruption and infarction of the placenta in conjunction with poor fetal growth and intrauterine fetal death.
Section snippets
Participants
Between April 1, 1990, and March 31, 2004, we did a retrospective population-based cohort study of women living in Ontario, Canada, using linked health-care administrative databases. All residents are enrolled in the Ontario Health Insurance Plan (OHIP), which covers all aspects of antenatal care, including maternal serum screening and ultrasonography, as well as hospital and postnatal care. The study cohort comprised all women admitted to hospital for the first obstetrical delivery of a
Results
During the study period, 1 033 559 pregnant women were admitted to hospital for delivery of their baby. Of these, we excluded 6396 women who did not live in Ontario, 447 women who were younger than age 14 years or older than age 50 years, 161 women who had been admitted for cardiovascular disease in the 24 months before delivery, and 290 women who died before the start of follow-up.
Of the remaining 1 026 265 women who had a first documented delivery during the study period, 75 380 (7%) were
Discussion
We noted a doubling of the risk of premature cardiovascular disease in women who had had a maternal placental syndrome during pregnancy compared with in those who had not. This risk was further increased by the concomitant presence of fetal growth restriction or intrauterine fetal death, or pre-existing risk factors for cardiovascular disease, including features of the metabolic syndrome and tobacco use.
Our study had various limitations. Satisfactory ascertainment of women with a maternal
References (42)
- et al.
The pathogenesis of pre-eclampsia
Gynecol Obstet Fertil
(2001) - et al.
The myometrial junctional zone spiral arteries in normal and abnormal pregnancies: a review of the literature
Am J Obstet Gynecol
(2002) - et al.
Relative glucose tolerance and subsequent development of hypertension in pregnancy
Obstet Gynecol
(2001) - et al.
Pregnancy complications and maternal risk of ischaemic heart disease: a retrospective cohort study of 129 290 births
Lancet
(2001) - et al.
Cardiovascular and thromboembolic events following hypertensive pregnancy
Am J Kidney Dis
(2003) - et al.
Fetal growth restriction: a workshop report
Placenta
(2004) - et al.
Risk factors associated with preeclampsia in healthy nulliparous women
Am J Obstet Gynecol
(1997) - et al.
The relationship between abnormal glucose tolerance and hypertensive disorders of pregnancy in healthy nulliparous women
Am J Obstet Gynecol
(1998) - et al.
Contribution of major cardiovascular risk factors to familial premature coronary artery disease: the GENECARD project
J Am Coll Cardiol
(2002) - et al.
Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study
Lancet
(2004)