Severe Maternal Morbidity and Long-Term Risk of Cardiovascular Hospitalization

Abstract

Background: Severe maternal morbidity is rising, yet the association with cardiovascular disease is not clear. We examined the risk of cardiovascular hospitalization up to 3 decades after having a pregnancy complicated by severe maternal morbidity. Methods: We analyzed a longitudinal cohort of 1 336 846 women who were pregnant between 1989 and 2019 in Quebec, Canada. The main exposure measure was severe maternal morbidity in any pregnancy, including severe preeclampsia, acute renal failure, sepsis, and other life-threatening conditions. Using time-varying Cox regression models, we compared the adjusted risk of hospitalization for cardiovascular disease up to 3 decades after pregnancy for women with severe maternal morbidity relative to women without severe morbidity. Results: Five percent of women had severe maternal morbidity. Overall, there were 68 287 cardiovascular hospitalizations during 21 725 672 person-years of follow-up in the cohort. Compared with no morbidity, women with any severe morbidity had a greater risk of cardiovascular hospitalization (hazard ratio [HR], 1.77 [95% CI, 1.72–1.82]). The association was the greatest within the first year of delivery (HR, 4.42 [95% CI, 3.77–5.19]) but persisted beyond 15 years (HR, 1.44 [95% CI, 1.37–1.51]). Having a cardiac complication (HR, 5.37 [95% CI, 4.65–6.20]), cerebrovascular accident (HR, 3.82 [95% CI, 2.94–4.96]), or acute renal failure (HR, 2.60 [95% CI, 2.15–3.14]) during pregnancy was strongly associated with future cardiovascular hospitalization. Conclusions: Women with severe maternal morbidity have a greater risk of cardiovascular disease after pregnancy, both in the short and long term. These women may benefit from active surveillance for cardiovascular disease.