Women who experience pregnancy complications such as gestational diabetes, preeclampsia, or preterm delivery have a significantly increased long-term risk of developing peripheral artery disease later in life, according to a study published July 21 in PLOS Medicine by Casey Crump of the University of Texas and colleagues.
Peripheral artery disease (PAD) is a condition characterized by narrowed arteries that reduce blood flow to the limbs. It affects more than 230 million people worldwide and is considered a strong predictor of future stroke, ischemic heart disease, and premature mortality. While adverse pregnancy outcomes have previously been identified as risk factors for other cardiovascular diseases, their association with long-term PAD risk had not been well established.
Researchers analyzed data from over 2.2 million women who had singleton deliveries in Sweden between 1973 and 2015. The study followed these women for PAD diagnoses using nationwide inpatient, outpatient, and primary care records through 2018. Five adverse pregnancy outcomes were examined: preterm delivery, small for gestational age infants, preeclampsia, other hypertensive disorders during pregnancy, and gestational diabetes.
During more than 54 million person-years of follow-up, 13,211 women (0.6%) were diagnosed with PAD at a median age of 62 years. All five adverse pregnancy outcomes were independently associated with an increased risk of developing PAD decades later. At 30–46 years after delivery, adjusted hazard ratios showed the highest risk linked to gestational diabetes (HR 3.83), followed by small for gestational age infants (HR 1.74), other hypertensive disorders (HR 1.61), preterm delivery (HR 1.58), and preeclampsia (HR 1.28). Women experiencing multiple adverse outcomes faced even greater risks; these associations persisted even after accounting for shared familial factors in co-sibling analyses.
"Because this was a relatively young cohort, the risks of PAD following adverse pregnancy outcomes may be even higher as women reach older ages when PAD is more likely to manifest," the authors write. "Women with pregnancy complications may warrant early cardiovascular risk assessment and long-term clinical follow-up given their higher subsequent risk of PAD," they add. "Pregnancy is a 'natural stress test' that may reveal higher cardiovascular risks in early adulthood... Women with pregnancy complications need early and long-term follow-up with their physician to reduce their lifetime risk of peripheral artery disease and other cardiovascular diseases."
