Pre-Term Deliveries Associated with Future Risk of Cardiovascular Events Interview with
Prof. Eyal Sheiner MD PhD
Senior Obstetrician

Soroka Medical Center, Israel What are the main findings of the study?

Dr. Sheiner: The study was aimed to investigate whether a history of preterm delivery (PTD) poses a risk for subsequent maternal long-term cardiovascular morbidity.

During the study period 47,908 women met the inclusion criteria; 12.5% (n=5992) patients delivered preterm. During a follow-up period of more than ten years, patients with PTD had higher rates of simple as well as complex cardiovascular events and higher rate of total cardiovascular related hospitalizations. A linear association was found between the number of previous PTD and future risk for cardiovascular hospitalizations (5.5% for two or more PTD, 5.0% for one PTD vs. 3.5% in the comparison group; P<0.001). The association remained significant for spontaneous vs. induced PTD and for early (<34 weeks) as well as late (34-36+6 weeks) PTD. In a Cox proportional hazards model that adjusted for pregnancy confounders such as labor induction, diabetes mellitus, preeclampsia and obesity, PTD was independently associated with cardiovascular hospitalizations (adjusted HR 1.4, 95% CI 1.2-1.6). Were any of the findings unexpected?

Dr. Sheiner: The link between pregnancy complications and future risk for cardiovascular disease (CVD) has been previously studied with a specific focus on preeclampsia and gestational diabetes mellitus. This evidence led to recent recommendations published by the American heart association, including preeclampsia and gestational diabetes mellitus in the guidelines for the preliminary risk evaluation for CVD in women.  The association between PTD and subsequent cardiovascular complication was not established previously and PTD was not part of the recommended risk-assessment. What should clinicians and patients take away from your report?

Dr. Sheiner: In assessing a patient’s risk for cardiovascular disease, the clinician may consider pregnancy with an adverse outcome to represent the equivalent of a physiologic stress test for the purpose of future risk assessment.

Women who previously have experienced preterm delivery might benefit from cardiovascular risk screening that could lead to early detection and perhaps secondary prevention of cardiovascular disease. What recommendations do you have for future research as a result of this study?

Dr. Sheiner:  Further large population based studies are needed to verify PTD as a risk for long term cardiovascular morbidity, and accordingly PTD should also be suggested to be part in the guidelines for the preliminary risk evaluation for CVD in women.


An association between preterm delivery and long-term maternal cardiovascular morbidity

Kessous R, Shoham-Vardi I, Pariente G, Holcberg G, Sheiner E.
Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

Am J Obstet Gynecol. 2013 Jun 22. pii: S0002-9378(13)00530-9. doi: 10.1016/j.ajog.2013.05.041. [Epub ahead of print]

Last Updated on July 18, 2013 by Marie Benz MD FAAD