Women with difficult pregnancies ‘could be at risk of heart problem for decades’

Women who have an “adverse outcomes” in pregnancy could be at higher risk of developing a heart condition up to 46 years later, a new long term study has found.

Academics said that women should be tracked over the long-term to help spot early signs of atrial fibrillation (AF) – a type of heart rhythm problem which puts patients at a higher risk of stoke.

They examined data on 2.2 million women who gave birth in Sweden between 1973 and 2015.

Their health records were scanned for information on diabetes in pregnancy; high blood pressure; whether or not their babies were born with a low or high birth weight; whether or not the mothers had pre-eclampsia and whether or not babies were born “preterm”.

During the follow up period, some 2.3% of the women were diagnosed with AF, with the average age at diagnosis 63 years old.

Writing in the journal JAMA Cardiology, the researchers said that all adverse pregnancy outcomes, apart from low birth weight of babies, were linked to a higher risk of AF in the long-term.

Within 10 years after giving birth, women who had hypertensive disorders during pregnancy, one of the most common complications of pregnancy including high blood pressure, had a 69% increased risk of developing AF.

Those whose babies were born preterm had a 46% increased risk within 10 years of giving birth.

And people whose babies were born large, also known as large for gestational age, had a 16% increased risk of developing AF up to 10 years later.

Researchers also examined data on AF risk between 30 and 46 years after women gave birth.

They found that women with pre-eclampsia in pregnancy continued to have a 38% increased risk of AF and those with other hypertensive disorders in pregnancy had a 44% increased risk.

Those who had diabetes in pregnancy, also known as gestational diabetes, had a 19% increased risk decades later and those whose babies were born early had an 11% increased risk.

Women who had multiple adverse pregnancy outcomes has “further increases in risk,” said the authors, who were led by experts from the University of Texas.

“In this large national cohort, all adverse pregnancy outcomes except small for gestational age were associated with increased risk for AF up to 46 years later,” they wrote.

“Women with adverse pregnancy outcomes need early preventive actions and long-term clinical follow-up for timely detection and treatment of cardiovascular disorders related to the development of AF.”

Commenting on the study, Dr Sonya Babu-Narayan, clinical director at the British Heart Foundation (BHF) and consultant cardiologist, said: “While observational studies show associations rather than direct causation, this large Swedish study adds to a growing body of evidence, including genetic research, that reproductive factors significantly influence women’s long-term cardiovascular health.

“Women may be surprised to learn that reproductive experiences – such as early periods, young maternal age, multiple miscarriages or stillbirths, a high number of live births, polycystic ovary syndrome (PCOS), endometriosis, pregnancy-related hypertension or diabetes, and early menopause – have been linked to increased risks of atrial fibrillation, coronary artery disease, heart failure, and stroke later in life.

“We need to empower women with knowledge about how their reproductive history could increase their chances of developing cardiovascular disease in the future. 

“Just as they would with cholesterol, blood pressure, or family history, healthcare professionals should be encouraged to routinely ask about reproductive cardiovascular risk factors when assessing women.”