Normotensive preterm delivery and maternal cardiovascular risk factor trajectories across the life course: The HUNT Study, Norway.

Abstract

Preterm delivery (<37weeks) predicts later cardiovascular disease risk in mothers, even among normotensive deliveries. However, development of subclinical cardiovascular risk before and after preterm delivery is not well understood. We sought to investigate differences in life course cardiovascular risk factor trajectories based on preterm delivery history. The HUNT Study (1984-2008) linked with the Medical Birth Registry of Norway (1967-2012) yielded clinical measurements and pregnancy outcomes for 19806 parous women with normotensive first deliveries. Women had up to three measurements of body mass index, waist-to-hip ratio, blood pressure, lipids, non-fasting glucose, and C-reactive protein during follow up between 21years before to 41years after first delivery. Using mixed effects models, we compared risk factor trajectories for women with preterm vs term/postterm first deliveries. Trajectories overlapped for women with preterm compared with term/postterm first deliveries for all cardiovascular risk factors examined. For instance, the mean difference in systolic blood pressure in women with preterm first deliveries compared with those with term deliveries was 0.2mmHg (95% CI -1.8 to 2.3) at age 20 and 1.5mmHg (95% CI -0.5 to 3.6) at age 60. A history of preterm delivery was not associated with different life course trajectories of common cardiovascular risk factors in our study population. This suggests that the robust association between preterm delivery and cardiovascular end points in Norway or similar contexts is not explained by one or more commonly measured cardiovascular risk factors. Overall, we did not find evidence for a single cardiovascular disease prevention strategy that would reduce risk among the majority of women who had preterm delivery.