Pregnancy complications associated with increased long-term risk of peripheral artery disease

Women who experience pregnancy complications such as gestational diabetes, preeclampsia or preterm delivery have a significantly increased long-term risk of developing peripheral artery disease (PAD) later in life, according to a new study published in PLOS Medicine by Casey Crump of the University of Texas, U.S., and colleagues.

PAD, a condition in which narrowed arteries reduce blood flow to the limbs, affects more than 230 million people worldwide and is a strong predictor of future stroke, ischemic heart disease and premature mortality. Adverse pregnancy outcomes have been identified as risk factors for other cardiovascular diseases, but their association with long-term PAD risk had not been well established.

A nationwide look at later PAD

In the new study, researchers analyzed data from 2,201,446 women who had a singleton delivery in Sweden between 1973 and 2015, following them for PAD diagnoses from nationwide inpatient, outpatient and primary care records through 2018. Five adverse pregnancy outcomes were examined: preterm delivery, small for gestational age, preeclampsia, other hypertensive disorders of pregnancy and gestational diabetes.

In 54 million person-years of follow-up, 13,211 women (0.6%) were diagnosed with PAD at a median age of 62. All five adverse pregnancy outcomes were independently associated with increased PAD risk.

Gestational diabetes showed the strongest link

At 30–46 years after delivery, adjusted hazard ratios were highest for gestational diabetes (HR 3.83, 95% CI 3.20–4.59), followed by small for gestational age (HR 1.74, 95% CI 1.65–1.83), other hypertensive disorders (HR 1.61, 95% CI 1.21–2.15), preterm delivery (HR 1.58, 95% CI 1.48–1.70) and preeclampsia (HR 1.28, 95% CI 1.20–1.37).

Women with multiple adverse pregnancy outcomes had further increases in risk. These findings were largely unexplained by shared familial factors in co-sibling analyses.

Pregnancy complications as an early warning

"Because this was a relatively young cohort, the risks of PAD following adverse pregnancy outcomes may be even higher as women reach older ages when PAD is more likely to manifest," the authors write. "Women with pregnancy complications may warrant early cardiovascular risk assessment and long-term clinical follow-up given their higher subsequent risk of PAD."

The authors add, "Pregnancy is a 'natural stress test' that may reveal higher cardiovascular risks in early adulthood. In a population of >2 million women, we found that all five major adverse pregnancy outcomes (preterm delivery, small for gestational age, preeclampsia, other hypertensive disorders and gestational diabetes) are independently linked with higher risks of peripheral artery disease up to 46 years later.

"Women with pregnancy complications need early and long-term follow-up with their physician to reduce their lifetime risk of peripheral artery disease and other cardiovascular diseases."

This article was originally published on MedicalXpress Breaking News-and-Events.