Medical Research Council Centre for Causal Analyses in Translational Epidemiology, University of Bristol, Oakfield House, Oakfield Grove, Bristol, United Kingdom.
Circulation. 2012 Mar 20;125(11):1367-80. doi: 10.1161/CIRCULATIONAHA.111.044784. Epub 2012 Feb 17.
The nature and contribution of different pregnancy-related complications to future cardiovascular disease (CVD) and its risk factors and the mechanisms underlying these associations remain unclear.
We studied associations of pregnancy diabetes mellitus, hypertensive disorders of pregnancy, preterm delivery, and size for gestational age with calculated 10-year CVD risk (based on the Framingham score) and a wide range of cardiovascular risk factors measured 18 years after pregnancy (mean age at outcome assessment, 48 years) in a prospective cohort of 3416 women. Gestational diabetes mellitus was positively associated with fasting glucose and insulin, even after adjustment for potential confounders, whereas hypertensive disorders of pregnancy were associated with body mass index, waist circumference, blood pressure, lipids, and insulin. Large for gestational age was associated with greater waist circumference and glucose concentrations, whereas small for gestational age and preterm delivery were associated with higher blood pressure. The association with the calculated 10-year CVD risk based on the Framingham prediction score was odds ratio 1.31 (95 confidence interval, 1.11-1.53) for preeclampsia and 1.26 (95 confidence interval, 0.95-1.68) for gestational diabetes mellitus compared with women without preeclampsia and without gestational diabetes mellitus, respectively.
Hypertensive disorders of pregnancy and pregnancy diabetes mellitus are independently associated with an increased calculated 10-year CVD risk. Preeclampsia may be the better predictor of future CVD because it was associated with a wider range of cardiovascular risk factors. Our results suggest that pregnancy may be an important opportunity for early identification of women at increased risk of CVD later in life.
不同妊娠相关并发症对未来心血管疾病（CVD）及其风险因素的性质和贡献，以及这些关联的潜在机制尚不清楚。
我们研究了妊娠糖尿病、妊娠高血压疾病、早产和胎儿大小与计算的 10 年 CVD 风险（基于弗雷明汉评分）以及妊娠后 18 年测量的广泛心血管风险因素之间的关联在一个前瞻性队列的 3416 名女性中。妊娠糖尿病与空腹血糖和胰岛素呈正相关，即使在调整了潜在混杂因素后也是如此，而妊娠高血压疾病与体重指数、腰围、血压、血脂和胰岛素有关。大于胎龄与更大的腰围和葡萄糖浓度有关，而小于胎龄和早产与更高的血压有关。与基于弗雷明汉预测评分的计算的 10 年 CVD 风险的关联为子痫前期的比值比 1.31（95%置信区间，1.11-1.53），妊娠糖尿病为 1.26（95%置信区间，0.95-1.68），与没有子痫前期和没有妊娠糖尿病的女性相比。
妊娠高血压疾病和妊娠糖尿病与计算的 10 年 CVD 风险增加独立相关。子痫前期可能是未来 CVD 的更好预测指标，因为它与更广泛的心血管风险因素有关。我们的结果表明，妊娠可能是早期识别一生中 CVD 风险增加的女性的重要机会。
