Hypertension, preterm delivery, gestational diabetes and fetal growth restriction increase women’s chances of developing cardiovascular disease.
Women with pregnancy complications such as hypertensive disorders of pregnancy, preterm delivery, gestational diabetes and fetal growth restriction have a higher risk of developing cardiovascular disease in the future, research suggests.
“It is important for clinicians to recognise adverse pregnancy outcomes as strong cardiovascular risk factors when risk stratifying women,” the authors of the literature review wrote.
But the paper, published in Maturitas, also found breastfeeding helped mitigate this risk.
“Women, particularly those with adverse pregnancy outcomes, need to be informed of the protective effects of breastfeeding shown to reduce the risk of CVD and other comorbidities.”
According to the review of 19 studies from the US, Europe and Asia tracking pregnancies over the last 80 years, around 30% of women experience an adverse outcome during pregnancy.
A history of adverse pregnancy outcomes was linked to higher rates of hypertension, diabetes, hyperlipidaemia, coronary artery disease, heart failure and stroke, the authors said. And these conditions appeared to develop at a younger age than those with uncomplicated pregnancies.
“Pregnancy has been described as a women’s first cardiovascular stress test, whereby the development of adverse pregnancy outcomes in pregnancy represents a failed stress test,” the authors wrote.
One meta-analysis including 13 million women found that hypertensive disorders of pregnancy were associated with a two-fold increase in the odds of cardiovascular disease, including coronary artery disease, peripheral vascular disease and stroke.
Preterm delivery was also associated with a higher risk for hypertension, diabetes and hyperlipidaemia in the decade after pregnancy.
“In a national registry-based cohort of over two million women, preterm delivery was associated with adjusted hazard ratios of 1.61-fold higher risk for haemorrhagic and ischemic stroke, 2.47- fold for ischemic heart disease, 1.73-fold for all-cause mortality, and 1.79-fold for cardiovascular mortality,” the authors wrote.
Likewise, women who developed gestational diabetes had twice the risk of cardiovascular disease as women with no history of the condition. As many as one in five of these women develop metabolic syndrome in the first three months postpartum.
There was also a significant inverse relationship between a baby’s body weight and the mother’s cardiovascular morbidity and mortality.
“One meta-analysis showed that for every standard deviation higher birth weight of the firstborn child, maternal CVD mortality is decreased by 25%,” the authors wrote.
But breastfeeding appeared to play an important role in reducing future cardiovascular risk in women.
“There is emerging evidence that lactation has long-term cardioprotective effects by counteracting metabolic stresses during pregnancy,” they wrote.
“Women who breastfeed have lower fasting blood glucose, diabetes, hypertension, obesity, and cholesterol, and these benefits have also been noted in women with pregnancies complicated by adverse pregnancy outcomes.”
Several studies found a link between longer duration of lactation and lower risk of stroke, while other studies found a link between lactation and reduced cardiovascular disease hospitalisation and mortality.
One study found that women who breastfed for six or more months had half the odds of developing diabetes and non-alcoholic fatty liver disease in mid-life.
The authors said risk prevention was essential for women with a history of adverse pregnancy outcomes.
“Lifestyle modifications including smoking cessation, healthy diet, regular physical activity and weight management are essential to decrease CVD risk in women with history of adverse pregnancy outcomes.”
The authors pointed to the American College of Obstetricians and Gynecologists (ACOG) and American Heart Association recommendations for blood pressure screening at six to 12 months postpartum and annually, as well as an annual risk assessment for atherosclerotic cardiovascular disease, including body mass index, fasting lipids and blood glucose, in women with a history of adverse pregnancy.
“Recognition and better understanding of the long-term cardiovascular implications of adverse pregnancy outcomes is of particular importance considering that CVD remains the principal cause of death in women globally, accounting for 35% of the total mortality,” the authors wrote.
