Journal
ANNALS OF EPIDEMIOLOGY
Volume 20, Issue 8, Pages 604-609Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.annepidem.2010.05.007
Keywords
Premature Birth; Cardiovascular Disease; Pregnancy; Women
Categories
Funding
- Danish Medical Research Council [271-05-0616]
- RAND-University of Pittsburgh Health Institute
- Magee Womens Research Institute
- Danish Cancer Society [DP04127]
- NIH [BIRCWH-K12HD043441-06]
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PURPOSE: Preterm birth (PTB) has been associated with a later increased risk of maternal cardiovascular disease (CVD). We hypothesized a more pronounced relation between early or recurrent PTB and maternal CVD risk. METHODS: We related PTB severity (earlier gestational age at delivery) and recurrence (>= 2) among women with births from 1973-1983 in Denmark (n = 427,765) to maternal CVD morbidity or mortality (1977-2006). Birth data were linked to CVD hospitalizations and deaths identified in national registers and data were analyzed using Cox proportional hazards models. RESULTS: Women with a prior PTB had excess CVD after adjustment for age, parity, and education (hazard ratio [HR] = 1.36 [95% confidence interval (Cl): 1.31, 1.41]). This was only modestly attenuated when women with preeclampsia or small for gestational age births were excluded, and the relationship was stronger for CVD mortality (HR = 1.98 [1.73, 2.26]). Recurrent PTB was associated with higher CVD morbidity compared to women with one PTB, particularly for ischemic events (HR = 1.78 [1.40, 2.27] vs. 1.22 [1.09, 1.36]). Risk was similarly elevated among women with early, moderate, and late PTB. Sensitivity analysis suggested that confounding by smoking only partly explained these associations. CONCLUSIONS: Women with PTB, especially recurrent PTB, were at increased risk for CVD, suggesting common causes of these conditions. Ann Epidemiol 2010;20:604-609. (C) 2010 Elsevier Inc. All rights reserved.
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