Multi-Fetal Pregnancy, Preeclampsia, and Long-Term Cardiovascular Disease

Author:

Bergman Lina12ORCID,Nordlöf-Callbo Paliz1,Wikström Anna Karin1,Snowden Jonathan M.34,Hesselman Susanne1,Edstedt Bonamy Anna Karin5,Sandström Anna145

Affiliation:

1. From the Department of Women’s and Children’s Health, Uppsala University, Sweden (L.B., P.N.-C., A.K.W., S.H., A.S.)

2. Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Sweden (L.B.)

3. School of Public Health, Oregon Health and Science University-Portland State University (J.M.S.)

4. Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland (J.M.S., A.S.)

5. Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden (A.K.E.B., A.S.)

Abstract

This Swedish register-based cohort study determined the separate and joint contribution of preeclampsia and multi-fetal pregnancy on a woman’s risk of cardiovascular disease (CVD) later in life. The study included 892 425 first deliveries between 1973 and 2010 of women born 1950 until 1971, identified in the Swedish Medical Birth Register. A composite outcome of CVD was retrieved through linkage with the National Patient and Cause of Death Registers. Cox proportional hazard regression was used to assess the risk of CVD in women who had preeclampsia in a singleton or multi-fetal pregnancy, adjusting for potential confounders, and presented as adjusted hazard ratios. Compared with women who had a singleton pregnancy without preeclampsia (the referent group), women with preeclampsia in a singleton pregnancy had an increased risk of CVD (adjusted hazard ratio 1.75 [95% CI, 1.64–1.86]). Women who had a multi-fetal pregnancy without or with preeclampsia did not have an increased risk of future CVD (adjusted hazard ratios 0.94 [95% CI, 0.79–1.10] and 1.25 [95% CI, 0.83–1.86], respectively). As opposed to preeclampsia in a first singleton pregnancy, preeclampsia in a first multi-fetal pregnancy was not associated with increased risk of future CVD. This may support the theory that preeclampsia in multi-fetal pregnancies more often occurs as a result of the larger pregnancy-related burden on the maternal cardiovascular system and excessive placenta-shed inflammatory factors, rather than the woman’s underlying cardiovascular phenotype.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Internal Medicine

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