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Abstract
A history of preterm or small (SGA) or large (LGA) for gestational age offspring is associated with smoking and unfavorable levels of BMI, blood pressure, glucose and lipids. Whether and to what extent the excess cardiovascular risk observed in women with these pregnancy complications is explained by conventional cardiovascular risk factors (CVRFs) is not known. We examined the association between a history of SGA, LGA or preterm birth and cardiovascular disease among 23,284 parous women and quantified the contribution of individual CVRFs to the excess cardiovascular risk using an inverse odds weighting approach. The hazard ratios (HR) between SGA and LGA offspring and CVD were 1.30 (95% confidence interval (CI) 1.15, 1.48) and 0.89 (95% CI 0.76, 1.03), respectively. Smoking explained 49% and blood pressure may have explained ≈12% of the excess cardiovascular risk in women with SGA offspring. Women with preterm birth had a 24% increased risk of CVD (HR 1.24, 95% CI 1.06, 1.45), but we found no evidence for CVRFs explaining any of this excess cardiovascular risk. While smoking explains a substantial proportion of excess cardiovascular risk in women with SGA offspring and blood pressure may explain a small proportion in these women, we found no evidence that conventional CVRFs explain any of the excess cardiovascular risk in women with preterm birth.
Highlights
A history of preterm or small (SGA) or large (LGA) for gestational age offspring is associated with smoking and unfavorable levels of body mass index (BMI), blood pressure, glucose and lipids
In order to inform targeted cardiovascular disease (CVD) prevention programs in women who gave birth to SGA or LGA offspring or experienced preterm birth, it is crucial to understand the relative contribution of these modifiable cardiovascular risk factors to the excess cardiovascular risk experienced by these women. Previously16, we examined the role of cardiovascular risk factors in explaining the excess cardiovascular risk in women who experienced preeclampsia or gestational hypertension, finding that a substantial part of the excess risk could be explained by elevated blood pressure and BMI
We take the same approach to investigate how much of the excess cardiovascular risk in women who experienced preterm birth or had SGA or LGA offspring can be explained by conventional cardiovascular risk factors
Summary
A history of preterm or small (SGA) or large (LGA) for gestational age offspring is associated with smoking and unfavorable levels of BMI, blood pressure, glucose and lipids. While smoking explains a substantial proportion of excess cardiovascular risk in women with SGA offspring and blood pressure may explain a small proportion in these women, we found no evidence that conventional CVRFs explain any of the excess cardiovascular risk in women with preterm birth. Pregnancy complications are an early marker of later cardiovascular disease (CVD) in women and could provide an opportunity for targeted CVD p revention1 Both giving birth to small and large for gestational age (SGA and LGA) offspring have been reported to be associated with an increased risk of CVD2–5. We take the same approach to investigate how much of the excess cardiovascular risk in women who experienced preterm birth or had SGA or LGA offspring can be explained by conventional cardiovascular risk factors
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