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Heart disease is the leading cause of death among U.S. women, but prediction tools are imperfect and not universally available. Pregnancy can reveal propensities for long-term poor health: Women with gestational diabetes are more likely to develop diabetes outside of pregnancy, and hypertensive disorders of pregnancy are associated with cardiovascular complications later in life. Investigators used the National Health and Nutrition Examination Survey (NHANES) to estimate risk for ischemic heart disease (IHD; self-reported coronary heart disease, angina, or myocardial infarction) among women who delivered small-for-gestational-age (SGA) neonates (<2500 g at >37 weeks).
Among 6608 women with term deliveries, 7% had IHD and 5% had delivered an SGA infant. After adjustment for traditional cardiovascular risk factors, including age, smoking, cholesterol, and C-reactive protein levels, the odds of IHD were significantly higher among women with a previous SGA infant (odds ratio, 1.7). This effect size was comparable to those of the strongest IHD risk factors: hypertension and diabetes. Although SGA was more prevalent among smokers, the independent association between SGA and IHD was noted among both smokers and nonsmokers. Median time between last delivery and incident IHD was 30 years.
Bukowski R et al. Delivery of a small for gestational age infant and greater maternal risk of ischemic heart disease. PLoS ONE 2012 Mar; 7:e33047. (http://dx.doi.org/10.1371/journal.pone.0033047)
Comment
The occurrence of pregnancy complications such as small-for-gestational-age neonates should serve as a warning for longer-term health concerns, and strategies to prevent ischemic heart disease in this population of women should be explored. Although the limitations of the NHANES data preclude ascertainment that the association between SGA neonates and maternal IHD is entirely independent of other pregnancy complications, the relation between the two is still important to note. Pregnancy is a rigorous cardiovascular stress test, the results of which should not be ignored after the 6-week postpartum visit, but rather incorporated into the patient's cardiovascular risk profile. To do this, however, we will need to move outside the silos inherent in traditional models of care and make better use of communication strategies such as electronic medical records to relay these outcomes after pregnancy care is completed.