Maternal risk of ischaemic heart disease following elective and spontaneous preterm delivery: Retrospective cohort study of 750 350 singleton pregnancies

  • C.E. H
  • G.C.S. S
  • D. M
 et al. 
  • 2

    Readers

    Mendeley users who have this article in their library.
  • N/A

    Citations

    Citations of this article.

Abstract

Introduction: Previous studies have demonstrated an overall association between preterm delivery and maternal risk of subsequent ischaemic heart disease (IHD). The underlying mechanism for this is unknown. Furthermore, it is not known whether the association is specific to either elective or spontaneous preterm delivery. Our study examined the associations by type of preterm delivery with a view to helping to elucidate the mechanism underlying the association between preterm delivery and maternal IHD risk. Methods: We linked three Scottish routine data sources. The Scottish Health Survey (lifestyle risk factors including blood samples), Scottish Morbidity Record (all acute hospital admissions and all pregnancies) and death certificate data. Univariate and multivariate Cox proportional hazards models were used to explore the associations between preterm delivery and subsequent IHD events and deaths. Univariate and multivariate linear regression analyses were used to study the associations between preterm delivery and subsequent C reactive protein (CRP) concentration. Results: The cohort comprised 750 350 women who delivered a live, singleton infant following their first pregnancy. We demonstrated independent associations between preterm delivery and death due to IHD (HR 2.26, 95% CI 1.88 to to 2.71) and total IHD events (HR 1.58, 95% CI 1.47 to to 1.71). The associations were significantly greater for elective than spontaneous preterm delivery (p=0.005). There was a trend whereby the association between preterm delivery and IHD increased with decreasing age at first IHD event. CRP concentration was available in 1124 women. There was a significant overall association between preterm delivery and CRP (β=0.053, p=0.046) but, on sub-group analysis, this was found to be specific to elective preterm delivery (β=0.077, p=0.004). Conclusions: Elective preterm delivery is usually undertaken because of growth restriction or pre-eclampsia, resulting from placental dysfunction. The association between elective preterm delivery and both IHD with CRP, and the trend over age, suggests that a genetic predisposition to a pro-inflammatory state may be a common mechanism predisposing to both placental dysfunction and IHD.

Author-supplied keywords

  • C reactive protein
  • blood sampling
  • cohort analysis
  • death
  • death certificate
  • female
  • genetic predisposition
  • health survey
  • heart muscle ischemia
  • hospital admission
  • human
  • infant
  • inflammation
  • ischemic heart disease
  • lifestyle
  • linear regression analysis
  • morbidity
  • placenta disorder
  • preeclampsia
  • pregnancy
  • premature labor
  • primigravida
  • proportional hazards model
  • risk
  • risk factor
  • society

Get free article suggestions today

Mendeley saves you time finding and organizing research

Sign up here
Already have an account ?Sign in

Find this document

Authors

  • Hastie C.E.

  • Smith G.C.S.

  • MacKay D.

  • Pell J.P.

Cite this document

Choose a citation style from the tabs below

Save time finding and organizing research with Mendeley

Sign up for free