Adverse pregnancy outcomes implicated in coronary artery disease

Coronary artery disease appears to be common among women with a history of adverse pregnancy outcomes, including those estimated to be at low risk of cardiovascular disease, according to a study.

The study included 10,528 women (median age 57.3 years), with data drawn from the Swedish Cardiopulmonary Bioimage Study. Researchers estimated the association between coronary computed tomography (CT) angiography indexes (coronary atherosclerosis, significant stenosis, noncalcified plaque, segment involvement score of ≥4, and coronary artery calcium score >100) and adverse pregnancy outcomes (pre-eclampsia, gestational hypertension, preterm delivery, small-for-gestational-age infant, and gestational diabetes).

Of the women, 18.9 percent had a history of adverse pregnancy outcomes, ranging from gestational diabetes (1.4 percent) to preterm delivery (9.5 percent). The prevalence of any coronary atherosclerosis was 32.1 percent (95 percent confidence interval [CI], 30.0–34.2) among women with a history of any adverse pregnancy outcome. This was significantly higher than that recorded among women without such a history (prevalence difference, 3.8 percent, 95 percent CI, 1.6–6.1; prevalence ratio, 1.14, 95 percent CI, 1.06–1.22).

Of note, the prevalence of all CT outcomes was higher among women with a history of gestational hypertension and those with a history of pre-eclampsia. In the group of women with a history of pre-eclampsia, the highest prevalence difference was observed for any coronary atherosclerosis (prevalence difference, 8.0 percent, 95 percent CI, 3.7–12.3; prevalence ratio, 1.28, 95 percent CI, 1.14–1.45), and the highest prevalence ratio was observed for significant stenosis (prevalence difference, 3.1 percent, 95 percent CI, 1.1–5.1; prevalence ratio, 2.46,95 percent CI, 1.65–3.67).

In multivariable regression models, pre-eclampsia was associated with greater odds of any coronary atherosclerosis (odds ratio [OR], 1.31, 95 percent CI, 1.07–1.61) and significant stenosis (OR, 2.21, 95 percent CI, 1.42–3.44). Associations between a history of pre-eclampsia or gestational hypertension and CT outcomes were similar among women with low predicted cardiovascular risk.