BACKGROUND AND PURPOSE:

• There is a link between preterm delivery and increased future risks of cardiometabolic disorders
• Data related to the long-term risks specifically for ischemic heart disease (IHD) and long-term implications remain limited
• Crump et al. (Journal of the American College Cardiology, 2020) assessed the long-term risks of IHD in women based on pregnancy duration

METHODS:

• National cohort study (Sweden)
• Participants
  • All women with a singleton delivery from 1973 to 2015
• Study design
  • Women were followed up for IHD through the end of 2015
  • Adjusted hazard ratios (aHRs) for IHD associated with pregnancy duration were calculated
  • In addition, cosibling analyses was used to assess the influence of shared familial (genetic and/or environmental) factors

RESULTS:

• 2,189,190 women were included
  • Follow-up: 47.5 million person-years
  • Diagnosis of IHD: 2.3% of women
• Within 10 years following delivery, the aHR for IDH was as follows  
  • Overall preterm delivery (<37 weeks): aHR 2.47 (95% CI, 2.16 to 2.82)
  • Extremely preterm (22 to 27 weeks): aHR 4.04 (95% CI, 2.69 to 6.08)
  • Very preterm (28 to 33 weeks): aHR 2.62 (95% CI, 2.09 to 3.29)
  • Late preterm (34 to 36 weeks): aHR 2.30 (95% CI, 1.97 to 2.70) 
  • Early term (37 to 38 weeks): aHR 1.47 (95% CI, 1.30 to 1.65)
• The risks for IHD declined but remained significantly elevated after additional follow-up (preterm vs. full-term)
  • 10 to 19 years: aHR 1.86 (95% CI, 1.73 to 1.99)
  • 20 to 29 years: aHR 1.52 (95% CI, 1.45 to 1.59)
  • 30 to 43 years: aHR 1.38 (95% CI, 1.32 to 1.45)
• Cosibling analysis did not alter the findings
• Additional pre-term deliveries were associated with further increases in risk

CONCLUSION:

• Prior preterm delivery was a strong independent risk factor for ischemic heart disease
• The association decreased over time but was still substantially elevated even up to 40 years after delivery
• These findings did not appear to be attributable to shared genetic or environmental factors within families
• The authors propose that preterm delivery be recognized as a risk factor for IHD across the life course and recommend that

Women who deliver prematurely need early preventive evaluation and long-term monitoring for IHD

Learn More – Primary Sources:

Pre-Term Delivery and Risk of Ischemic Heart Disease in Women

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