Pregnancy Complications Increase Risk of Heart Disease In Women

Barbara A. Cohn, PhD Director of the Child Health and Development Studies at the Public Health Institute. Berkeley, California MedicalResearch.com Interview with:
Barbara A. Cohn, PhD
Director of the Child Health and Development Studies at the Public Health Institute.
Berkeley, California

Medical Research: What is the background for this study?

Dr. Cohn: I guessed that pregnancy complications would be an early warning sign of cardiovascular problems because of the extraordinary demands that pregnancy places on a woman’s cardiovascular system.

Medical Research: What data were used for this study?

Dr. Cohn: The Child Health and Development Studies is a large pregnancy cohort that enrolled more than 20,000 pregnancies in the 1960’s. Women and their families have been followed now for more than 50 years. Information on pregnancy complications was captured from medical records as they occurred, long before cardiovascular disease developed. These data are the basis for the current study.

Medical Research: Why hasn’t this study already been done?

Dr. Cohn: Long-term, large studies of pregnancy are rare. I first tried to do this study forty years ago when I was in graduate school. At that time, Dr. Bea van den Berg, the late, second director of the Child Health and Development Studies advised that the study mothers were still too young to observe their cardiovascular disease experience.

Now 40 years later, my colleague Piera Cirillo and I have been able to test the idea that combinations of pregnancy complications are linked to cardiovascular disease death for women.

Dr. Cohn: Medical Research: What are the main findings?

  1. We discovered that some combinations of pregnancy complications were associated with as much as a 7-fold increase in risk of cardiovascular disease death overall.
  2. Other complications were associated with a 4- to 5-fold higher risk of dying of cardiovascular disease early, before the age of 60. For example, gestational hypertension in combination with preterm delivery predicted a 5-fold increase in risk of early death from cardiovascular disease; and pre-eclampsia accompanied by delivery of a small-for-gestational-age infant predicted a 4-fold increase in risk of early death from cardiovascular disease.
  3. We also found 2 new risk factors for cardiovascular disease death: the presence of sugar in the urine during pregnancy and a particular pattern of decline in hemoglobin during pregnancy.

Medical Research: If a woman has had one or more of these pregnancy complications, what should she do?

Dr. Cohn:

  1. I would suggest that she discuss this with her doctor, because her doctor may decide she is a candidate for discussing cardiovascular disease prevention at an earlier age than they might otherwise.
  2. There is no cost or procedure associated with this. Even if a woman doesn’t remember her own pregnancy history, this information is easy to access in her medical record.
  3. The first doctor many young women talk to is an obstetrician, and their obstetrician could either refer the woman to a physician who addresses cardiovascular health, or work with them as a primary provider to talk about other risk factors in the woman’s control that could help extend her life.

MedicalResearch: Based on your findings, what should primary care physicians (including OBGYNs) do with patients who have had these pregnancy complications?

Dr. Cohn:

  1. Every primary care provider who cares for a woman should ask whether their patient has had these pregnancy complications – or check their medical record if the patient doesn’t remember.
  2. If she has, they should begin surveillance early and recommend preventive measures the patient can take to address risk factors they can control to help prevent early death.
  3. This is a low cost intervention that is easy to implement.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Cohn: We think that it would important to find biomarkers in early pregnancy, for example in blood, that correlate both with high risk pregnancy complications and cardiovascular disease risk. These studies could identify pathways to risk and lead to opportunities to protect mothers and also their infants.

Citation:

Piera M. Cirillo and Barbara A. Cohn. Pregnancy Complications and Cardiovascular Disease Death: Fifty-Year Follow-Up of the Child Health and Development Studies Pregnancy Cohort. Circulation, September 2015
DOI: 10.1161/CIRCULATIONAHA.113.003901

 

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Barbara A. Cohn, PhD (2015). Pregnancy Complications Increase Risk of Heart Disease In Women MedicalResearch.com