Elsevier

The Lancet

Volume 366, Issue 9499, 19–25 November 2005, Pages 1797-1803
The Lancet

Articles
Cardiovascular health after maternal placental syndromes (CHAMPS): population-based retrospective cohort study

https://doi.org/10.1016/S0140-6736(05)67726-4Get rights and content

Summary

Background

Maternal placental syndromes, including the hypertensive disorders of pregnancy and abruption or infarction of the placenta, probably originate from diseased placental vessels. The syndromes arise most often in women who have metabolic risk factors for cardiovascular disease, including obesity, pre-pregnancy hypertension, diabetes mellitus, and dyslipidaemia. Our aim was to assess the risk of premature vascular disease in women who had had a pregnancy affected by maternal placental syndromes.

Methods

We did a population-based retrospective cohort study in Ontario, Canada, of 1·03 million women who were free from cardiovascular disease before their first documented delivery. We defined the following as maternal placental syndromes: pre-eclampsia, gestational hypertension, placental abruption, and placental infarction. Our primary endpoint was a composite of cardiovascular disease, defined as hospital admission or revascularisation for coronary artery, cerebrovascular, or peripheral artery disease at least 90 days after the delivery discharge date.

Findings

The mean (SD) age of participants was 28·2 (5·5) years at the index delivery, and 75 380 (7%) women were diagnosed with a maternal placental syndrome. The incidence of cardiovascular disease was 500 per million person-years in women who had had a maternal placental syndrome compared with 200 per million in women who had not (adjusted hazard ratio [HR] 2·0, 95 CI 1·7–2·2). This risk was higher in the combined presence of a maternal placental syndrome and poor fetal growth (3·1, 2·2–4·5) or a maternal placental syndrome and intrauterine fetal death (4·4, 2·4–7·9), relative to neither.

Interpretation

The risk of premature cardiovascular disease is higher after a maternal placental syndrome, especially in the presence of fetal compromise. Affected women should have their blood pressure and weight assessed about 6 months postpartum, and a healthy lifestyle should be emphasised.

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

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