Crump Casey, Sundquist Jan, Sundquist Kristina
Departments of Family and Community Medicine and of Epidemiology, The University of Texas Health Science Center, Houston, Texas, USA.
Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden; University Clinic Primary Care Skåne, Region Skåne, Sweden.
JACC Heart Fail. 2025 Apr;13(4):589-598. doi: 10.1016/j.jchf.2024.11.004. Epub 2025 Jan 22.
Adverse pregnancy outcomes, such as preterm delivery and hypertensive disorders of pregnancy, may be associated with higher future risks of heart failure (HF). However, the comparative effects of different adverse pregnancy outcomes on long-term risk of HF, and their potential causality, are unclear.
The authors sought to examine 5 major adverse pregnancy outcomes in relation to long-term risk of HF in a large population-based cohort.
A national cohort study was conducted of all 2,201,638 women with a singleton delivery in Sweden in 1973-2015, followed up for HF identified from nationwide outpatient and inpatient diagnoses through 2018. Cox regression was used to compute HRs for HF associated with preterm delivery, small for gestational age, preeclampsia, other hypertensive disorders of pregnancy, and gestational diabetes, while adjusting for other adverse pregnancy outcomes and maternal factors. Co-sibling analyses assessed for potential confounding by shared familial (genetic or environmental) factors.
In 48 million person-years of follow-up, 667,774 women (30%) experienced an adverse pregnancy outcome, and 19,922 women (0.9%) were diagnosed with HF (median age, 61 years). All 5 adverse pregnancy outcomes were independently associated with long-term increased risk of HF. With up to 46 years of follow-up after delivery, adjusted HRs for HF associated with specific adverse pregnancy outcomes were: gestational diabetes, 2.19 (95% CI: 1.95-2.45); preterm delivery, 1.68 (95% CI: 1.61-1.75); other hypertensive disorders, 1.68 (95% CI: 1.48-1.90); preeclampsia, 1.59 (95% CI: 1.53-1.66); and small for gestational age, 1.35 (95% CI: 1.31-1.40). All HRs remained significantly elevated (1.3- to 3.0-fold) even 30 to 46 years after delivery. These findings were only partially explained by shared familial factors. Women with multiple adverse pregnancy outcomes had further increases in risk (eg, up to 46 years after delivery, adjusted HRs associated with 1, 2, or ≥3 adverse pregnancy outcomes were 1.51 [95% CI: 1.47-1.56], 2.31 [95% CI: 2.19-2.45], and 3.18 [95% CI: 2.85-3.56], respectively).
In this large national cohort, women who experienced any of 5 major adverse pregnancy outcomes had increased risk for HF up to 46 years later. Women with adverse pregnancy outcomes need early preventive actions and long-term clinical care to reduce the risk of HF.
不良妊娠结局，如早产和妊娠期高血压疾病，可能与未来心力衰竭（HF）风险升高有关。然而，不同不良妊娠结局对HF长期风险的比较影响及其潜在因果关系尚不清楚。
作者试图在一个大型人群队列中研究5种主要不良妊娠结局与HF长期风险的关系。
对1973年至2015年在瑞典单胎分娩的所有2201638名妇女进行全国队列研究，随访至2018年通过全国门诊和住院诊断确定的HF。采用Cox回归计算与早产、小于胎龄、先兆子痫、其他妊娠期高血压疾病和妊娠期糖尿病相关的HF风险比（HR），同时调整其他不良妊娠结局和母体因素。同胞分析评估了共享家族（遗传或环境）因素的潜在混杂作用。
在4800万人年的随访中，667774名妇女（30%）经历了不良妊娠结局，19922名妇女（0.9%）被诊断为HF（中位年龄61岁）。所有5种不良妊娠结局均与HF长期风险增加独立相关。分娩后长达46年的随访中，与特定不良妊娠结局相关的HF调整后HR为：妊娠期糖尿病，2.19（95%CI：1.95-2.45）；早产，1.68（95%CI：1.61-1.75）；其他高血压疾病，1.68（95%CI：1.48-1.90）；先兆子痫，1.59（95%CI：1.53-1.66）；小于胎龄，1.35（95%CI：1.31-1.40）。即使在分娩后30至46年，所有HR仍显著升高（1.3至3.0倍）。这些发现仅部分由共享家族因素解释。有多种不良妊娠结局的妇女风险进一步增加（例如，分娩后长达46年，与1、2或≥3种不良妊娠结局相关的调整后HR分别为1.51[95%CI：1.47-1.56]、2.31[95%CI：2.19-2.45]和3.18[95%CI：2.85-3.56]）。
在这个大型全国队列中，经历5种主要不良妊娠结局中任何一种的妇女在46年后发生HF的风险增加。有不良妊娠结局的妇女需要早期预防措施和长期临床护理以降低HF风险。
