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Effect of Pre-Eclampsia–Eclampsia on Major Cardiovascular Events Among Peripartum Women in Taiwan

https://doi.org/10.1016/j.amjcard.2010.08.073Get rights and content

There is no large-scale population-based study to clarify the association between major adverse cardiovascular events (MACEs) and pre-eclampsia/eclampsia. A population-based Taiwanese cohort study was performed in 1,132,064 parturients from 1999 to 2003 using a dataset linking birth certificates and National Health Insurance hospital discharge data. Sociodemographic factors and obstetric complications were used in multivariate logistic regression models to determine adjusted hazard ratios of pre-eclampsia/eclampsia on risks of MACEs and mortality during pregnancy to at least the third year postpartum. Incidence rates of MACEs and all maternal mortality in women with pre-eclampsia/eclampsia were 16.21 and 40.38 per 100,000 patients per year, respectively. Women with pre-eclampsia/eclampsia had a 13.0-fold higher incidence of myocardial infarction, a 8.3-fold higher incidence of heart failure, a 14.5-fold higher incidence of stroke, a 12.6-fold higher incidence of MACEs, a 7.3-fold higher incidence of MACEs without stroke, a 2.3-fold higher incidence of MACE-related deaths, and a 6.4-fold higher incidence of overall death than women without pre-eclampsia/eclampsia. Kaplan-Meier survival curve discriminated in MACEs, nonstroke MACEs, MACE related death and overall death. In conclusion, women with pre-eclampsia/eclampsia have a significantly higher risk of MACEs, especially myocardial infarction and stroke, during pregnancy and their risk remains significant to ≥36 months postpartum. Our results suggest that women with pre-eclampsia/eclampsia should be closely monitored during pregnancy and for up to ≥3 years postpartum.

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Methods

Data for this study were obtained from 3 main sources. The first source was birth registries from 1999 to 2003 provided by the ministry of the interior. This dataset contains comprehensive information about birth and parents' data, including age, education, marital status, infant birth weight, gestational weeks, infant sex, and multiple births. The second source was the NHI hospital discharge data covering 1996 to 2004, a nationwide population-based data including >21 million enrollees,

Results

There were 1,132,064 pregnancies identified during the study period; of these 68% of mothers were ∼25 to 34 years old, 97% of pregnancies were single gestation and 46% were nulliparous, and 724 cases of MACEs occurred from the third trimester of pregnancy to the end of 2004. Table 1 presents the distribution of MACE cases among sociodemographic and clinical groups.

Overall incidence of any MACE was 16.21 per 100,000 patients per year, of which >70% consisted of stroke cases. Heart failure was

Discussion

Different epidemiologic studies have demonstrated that women with pre-eclampsia/eclampsia develop complications with cardiovascular disease compared to a normal population.1, 2, 3, 4, 5, 6, 7, 8, 9 In 2001, from a cohort study of 129,290 pregnant women with 15-year follow-up, Smith et al3 found a strong correlation between complicated pregnancies and maternal risk of ischemic heart disease. Women with pre-eclampsia, preterm birth, and low birth weight were found to have a 16-fold higher risk

Acknowledgment

The authors thank the NHI bureau for its technical assistance in processing data for this study. Special thanks also go to Chien-Jen Chen, PhD, and San-Lin You, PhD, at Genomics Research Center, Academia Sinica, Taipei, Taiwan, and to Yi-Hua Chen, PhD, School of Public Health, Taipei Medical University, Taipei, Taiwan, for their advice on statistical analysis.

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This work was supported by Grants NHRI-EX95-9108SC and NHRI-EX969627SI from the National Health Research Institute, Taiwan; Grants NSC 96-2314-B182-026 and 97-2314-B-182-028-MY2 from the National Science Council, Taipei, Taiwan; Topnotch Stroke Research Center, Ministry of Education, Taipei, Taiwan; and Grant DOH-TD-B-111-002 from the Center of Excellence for Clinical Trial and Research in Neurology and Neurosurgery, Department of Health, Taipei, Taiwan.

Dr. Lin and Dr. Tang contributed equally to this work.

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