Cardiovascular Disease in Relation to Placental Abruption: A Population-Based Cohort Study from Denmark.
BACKGROUND
Cardiovascular (CVD) complications stemming from vascular dysfunction have been widely explored in the setting of preeclampsia. However, the impact of abruption, a strong indicator of microvascular disturbance, on the risk of CVD mortality and morbidity remains poorly characterised.


METHODS
We designed a cohort analysis of 828 289 women who delivered singletons in Denmark between 1978 and 2010. We linked the National Patient Registry and the Registry of Causes of Death to the Danish Birth Registry to ascertain CVD events. We estimated CVD risks in relation to abruption from Cox proportional hazards regression following adjustments for confounders.


RESULTS
With 13 231 562 person-years of follow-up of women with at least one delivery, 11 829 pregnancies were complicated by abruption. The median (interquartile range) follow-up in the non-abruption and abruption groups was 16 (8, 24) and 18 (10, 25) years, respectively. CVD mortality rates in women with and without abruption were 0.9 and 0.3 per 10 000 person-years, respectively (adjusted hazard ratio (HR) 2.7, 95% confidence interval (CI) 1.5, 5.0). The corresponding CVD morbidity complication rates were 16.7 and 10.0 per 10 000 person-years, respectively (HR 1.5, 95% CI 1.4, 1.8). The increased risks were evident for ischaemic heart disease, acute myocardial infarction, hypertensive heart disease, non-rheumatic valvular disease, and congestive heart failure.


CONCLUSIONS
This study shows increased hazards of CVD morbidity and mortality in relation to abruption. A better understanding of the pathogenesis of distorted placental microvasculature is needed as this appears to be a harbinger of CVD later in life.
['Ananth|Cande V|CV|0000-0002-0410-2595', 'Hansen|Anne Vinkel|AV|', 'Williams|Michelle A|MA|', 'Nybo Andersen|Anne-Marie|AM|']
D000037:Abruptio Placentae D000328:Adult D002318:Cardiovascular Diseases D002423:Cause of Death D003718:Denmark D005260:Female D005500:Follow-Up Studies D006801:Humans D009035:Mothers D011159:Population Surveillance D011247:Pregnancy D011249:Pregnancy Complications, Cardiovascular D015995:Prevalence D016016:Proportional Hazards Models D011446:Prospective Studies D012042:Registries D012307:Risk Factors D055815:Young Adult
cardiovascular disease placental abruption ischaemic placental disease preterm delivery prospective cohort study