Women who experience preeclampsia, gestational diabetes, or other adverse pregnancy outcomes may face up to a 46-year increased risk of developing atrial fibrillation, according to a recent study.
In a large Swedish national cohort study, investigators found that adverse pregnancy outcomes were associated with the long-term risk of experiencing atrial fibrillation (AF). Among over 2.2 million women followed for up to 46 years, 2.3% (n = 51,173) of them developed AF at a median age of 63 years. After adjusting for maternal and clinical factors, all adverse pregnancy outcomes except small for gestational age were linked to increased AF risk.
The investigators used data from the Swedish Medical Birth Register and national health records to evaluate the long-term cardiovascular implications of pregnancy complications. The cohort included women with singleton deliveries between 1973 and 2015, yielding 54 million person-years of follow-up. The investigators identified AF cases from nationwide inpatient and outpatient registers and employed Cox proportional hazards regression to estimate hazard ratios. Analyses were adjusted for maternal age, parity, education, income, smoking, body mass index, and preexisting conditions such as hypertension and diabetes. Cosibling analyses were conducted to control for shared familial genetic and environmental factors.
Risk patterns varied by time since delivery. Within 10 years postpartum, women with other hypertensive disorders, preterm delivery, or large-for-gestational-age infants had the greatest relative increases in AF risk. At 30 to 46 years postdelivery, the elevated risks persisted for preeclampsia, other hypertensive disorders, gestational diabetes, large-for-gestational-age infants, and preterm delivery.
Cosibling analyses confirmed that these associations weren't fully attributable to shared familial or environmental factors. When adjusted for postpregnancy hypertension, most associations—especially those involving preeclampsia and hypertensive disorders—were attenuated, suggesting mediation through chronic hypertension.
“Women with adverse pregnancy outcomes need early preventive actions and long-term clinical follow-up for timely detection and treatment of cardiovascular disorders related to the development of AF,” noted lead study author Casey Crump, MD, PhD, of the Department of Family and Community Medicine at the McGovern Medical School at The University of Texas Health Science Center, and colleagues.
The investigators reported no conflicts of interest.
Source: JAMA Cardiology