title: Pregnancy-related complications and incident cardiovascular disease
Creators: name: Al Bahhawi, Tariq
Publisher: name: University of Liverpool Repository
Year: 2025

description: Pregnancy-related complications and incident cardiovascular diseases
Introduction
Previous observational studies have suggested associations between pregnancy-related complications and an increased risk of incident cardiovascular disease. However, these studies have not sufficiently evaluated the impact of a broad range of pregnancy-related complications and common cardiovascular conditions. There is limited evidence for the association between coexisting multiple pregnancy-related complications and incident cardiovascular disease. In addition, the association between recurrent pregnancy-related complications and incident cardiovascular disease remains unclear.
Methods
Data from the Secure Anonymised Information Linkage (SAIL) Databank (linked health and care records across Wales) were utilised to create a retrospective cohort that included women aged 16–45 years who had their first pregnancy between 2000 and 2018. Data extracted included records for births and deaths, hospital admissions, outpatient services, emergency department and general practice visits and pregnancy-related information, such as maternal indicators and national community child health. Cox proportional hazards regression modelling was used to evaluate associations between pregnancy-related complications and incident cardiovascular disease.
Results
A total of 298,515 women were included in the study, of which 74,832 (25.1%) women experienced a pregnancy-related complication in their first pregnancy. The history of any pregnancy-related complication during the first pregnancy was associated with a higher risk of all cardiovascular conditions examined, including heart failure [hazard ratio (HR) 1.93 (95% confidence interval (CI)); 1.61-2.31)], ischaemic heart disease [HR 1.82 (1.58-2.10)], stroke [HR 1.39 (1.20-1.61)] and atrial fibrillation [HR 1.33 (1.08-1.65)]. Compared to women without previous pregnancy-related complications, women with history of multiple pregnancy-related complications had a higher risk of ischaemic heart disease [HR 2.88 (2.27-3.67)], stroke [HR 2.03 (1.55-2.65)], heart failure [HR 3.18 (2.34-4.32)] and atrial fibrillation [HR 1.80 (1.20-2.72)]. History of recurrent pregnancy-related complications were associated with an increased risk of incident cardiovascular disease after the second pregnancy among multiparous women [ischaemic heart disease HR 1.93 (1.26–2.95), stroke HR 1.89 (1.25–2.85), heart failure HR 3.61 (2.32–5.60) and atrial fibrillation HR 2.45 (1.38–4.37)]. In comparison to women without a history of pregnancy-related complications and prevalent hypertension or diabetes, women who had both conditions had the highest risk for incident cardiovascular disease [HR 7.66 (6.25–9.40)] followed by women with prevalent hypertension or diabetes only [HR 4.36 (3.33–5.70)] and women with pregnancy-related complications only [HR 1.58 (1.45–1.73)].
Conclusion
Women who experience pregnancy-related complications have a higher risk of cardiovascular disease, which is further increased by multiple and recurrent pregnancy-related complications. Therefore, cardiovascular risk assessment and primary preventive measures for cardiovascular disease among women who experience pregnancy-related complications should be considered to help mitigate this increased risk.