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Maternal risk of ischaemic heart disease following elective and spontaneous pre-term delivery: retrospective cohort study of 750 350 singleton pregnancies.
MedLine Citation:
PMID:  21278195     Owner:  NLM     Status:  Publisher    
BACKGROUND: Previous studies have demonstrated an overall association between pre-term delivery and maternal risk of subsequent ischaemic heart disease (IHD). The underlying mechanism is unknown. We explored whether the association was specific to spontaneous or elective pre-term delivery. METHODS: We linked three Scottish routine data sources. The Scottish Morbidity Record 1 collects data on all acute hospital admissions, Scottish Morbidity Record 2 collects data on all pregnancies and Scotland's Registrar General collates data from all death certificates. Cox proportional hazards models were used to explore associations between pre-term delivery and subsequent IHD events (fatal and non-fatal) and IHD deaths. Analysis was restricted to women aged between 35 and 65 years at either the time of their first IHD event or at the end of follow-up. RESULTS: The cohort comprised 750 350 women who delivered a live, singleton infant following their first pregnancy. We demonstrated independent associations between pre-term delivery and IHD death [hazards ratio (HR) 2.26, 95% confidence interval (CI) 1.88-2.71] and total IHD events (HR 1.58, 95% CI 1.47-1.71). Associations were greater for elective than spontaneous pre-term delivery (P = 0.005). There was a trend whereby the association between pre-term delivery and IHD increased with decreasing age at first event. CONCLUSIONS: We observed a stronger association between elective pre-term delivery and IHD, than spontaneous pre-term delivery and IHD. Elective pre-term delivery is usually undertaken because of growth restriction or pre-eclampsia, resulting from placental dysfunction. The age trend observed suggests an underlying genetic predisposition to both placental dysfunction and IHD.
Claire E Hastie; Gordon Cs Smith; Daniel F Mackay; Jill P Pell
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-1-28
Journal Detail:
Title:  International journal of epidemiology     Volume:  -     ISSN:  1464-3685     ISO Abbreviation:  -     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-1-31     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802871     Medline TA:  Int J Epidemiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
British Heart Foundation Cardiovascular Research Centre, University of Glasgow, UK, Department of Obstetrics and Gynaecology, University of Cambridge, UK, Section of Public Health, University of Glasgow, UK and Section of Public Health, University of Glasgow, UK.
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