Tariq Al Bahhawi, Stephanie L. Harrison, Deirdre A. Lane, Flemming Skjøth, Iain Buchan, Andrew Sharp, Hoda Abbasizanjani, Ashley Akbari, Fatemeh Torabi, Julian Halcox, Dharani K. Hapangama, Gregory Y. H. Lip
BACKGROUND: Pregnancy-related complications are linked to increased cardiovascular disease risk, but comprehensive evaluations of diverse complications, particularly multiple or recurrent events, are limited. METHODS: A national retrospective cohort study was conducted using the Secure Anonymised Information Linkage (SAIL) Databank in Wales. Exposures were hypertensive disorders of pregnancy, gestational diabetes, placental abruption, stillbirth, small for gestational age, fetal growth restriction, and preterm birth. Multiple complications were defined as >1 complication in the first pregnancy, and recurrent complications as the same complication in both the first and second pregnancies. Outcomes were incident ischemic heart disease, stroke, heart failure, and atrial fibrillation. Cox regression estimated hazard ratios (HRs). RESULTS: A total of 298 515 women (mean age 27.2 years; SD 6.1) were included. Multiple pregnancy-related complications were associated with increased risk of ischemic heart disease (hazard ratio HR, 2.88 [95% CI, 2.27-3.67]), stroke (HR, 2.03 [95% CI, 1.55-2.65]), heart failure (HR, 3.18 [95% CI, 2.34-4.32]), and atrial fibrillation (HR, 1.80 [95% CI, 1.20-2.72]) compared with no complications. A dose-response relationship was observed, with progressively higher cardiovascular disease risk for multiple compared with single complications and elevated risk for both groups relative to women without complications. Recurrent pregnancy-related complications increased the risk of ischemic heart disease (HR, 1.93 [95% CI, 1.26-2.95]), stroke (HR, 1.89 [95% CI, 1.25-2.85]), heart failure (HR, 3.61 [95% CI, 2.32-5.60]), and atrial fibrillation (HR, 2.45 [95% CI, 1.38-4.37]) compared with no complication. CONCLUSIONS: Women experiencing pregnancy-related complications encounter higher risks of cardiovascular disease, especially with multiple or recurrent complications. Comprehensive cardiovascular risks assessment and targeted prevention should be prioritized for this group.