Primary atherothrombotic occlusive vascular events in premenopausal women with history of adverse pregnancy outcome

Objective: To determine if adverse pregnancy outcomes are associated with atherothrombotic occlusive vascular disease (AOVD) in premenopausal women. Design: Retrospective matched case-control study. Setting: Tertiary, university-affiliated medical center. Population: Women aged less than 50 years treated for an AOVD (primary cerebrovascular, myocardial, or peripheral arterial ischemic event) from 1995 to 2004. Method: The files were reviewed for classical risk factors for AOVD and complications of pregnancy (abortions, pregnancy-induced hypertension, preeclampsia, gestational diabetes, intrauterine growth restriction (IUGR), fetal loss and preterm delivery). Findings were compared with healthy women matched for age and body mass index. Main outcome measures: Past pregnancy complications in premenopausal women with AOVD. Results: Of the 101 women with AOVD, 53 had a myocardial ischemic event, 33 a cerebrovascular event, and 15 a peripheral ischemic arterial event. On multivariate analysis, IUGR (OR 8.41, 95% CI 2.36-29.9, p = 0.001) and more than one pregnancy complication (OR 13.7, 95% CI 1.56-120, p = 0.02) were found to be independent significant variables associated with AOVD. Conclusion: IUGR and composite pregnancy complications are independent significant variables associated with AOVD in premenopausal period. Pregnancy outcome might serve as a means to identify patients who may require increased medical surveillance and preventive measures for later vascular disease. (C) 2009 Elsevier Ltd. All rights reserved.