Pregnancy outcomes, reproductive history and cardiovascular disease risk in women: What do we know and what is needed?
Abstract
Emerging evidence suggests that adverse pregnancy outcomes (APOs) predict cardiovascular disease (CVD) outcomes in women. Heida and colleagues extend this emerging evidence by summarizing the existing data on APOs and reproductive history, including meta-analyses of cohort and case–control studies. Specifically, gestational hypertension, preeclampsia, preterm delivery, small-for-gestational-age infant, recurrent miscarriage, polycystic ovary syndrome and premature ovarian insufficiency were examined systematically for the purposes of guideline generation. In brief, the review concludes that preeclampsia (RR 2.15, 95% confidence interval (CI): 1.76–2.61) qualifies for clinical follow-up, while the other APOs or reproductive conditions (most risk ratios (RRs)> 1.0 but 2 is somewhat arbitrary, thresholds rather than regression analyses are needed in order to assist healthcare providers and patients as they make decisions in clinical practice. That said, CVD is known to be multifactorial, and risk prediction scores universally include multiple risk factors. The comparability of the RRs of the APOs and reproductive variables with the traditional risk factor individual hazard ratios (95% CIs) for CVD in women suggests that a threshold of 2 may be premature (e.g. hypercholesterolemia: 1.06 (0.87– 1.30); smoking: 2.39 (1.76–3.26); hypertension: 2.02 (1.54–2.49); pre-hypertension: 1.38 (1.15–1.65); diabetes: 1.94 (1.4–2.67); family history of premature coronary artery disease (CAD):…
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