Assessing Cardiovascular Disease Risk among Young Women with a History of Delivering a Low-Birth-Weight Infant

Abstract

Objective To assess the prevalence and risk factors of cardiovascular disease (CVD) among younger women by pregnancy history.

Methods Cross-sectional study using 1999 to 2006 National Health and Nutrition Examination Survey including women aged 20 to 64 years who had delivered at least one infant (n = 4820). Women self-reported pregnancy history and a clinician diagnosed CVD; CVD risk factors included hypertension (mean systolic blood pressure [BP] ≥140 mm Hg or mean diastolic BP ≥90 mm Hg, or currently treated), high cholesterol (total cholesterol ≥240 mg/dL or currently treated), diabetes (self-report or hemoglobin A1c ≥6.5), and smoking (self-report or cotinine-verified). Multivariable logistic regression was used to assess the association between pregnancy history and CVD.

Results Of the women we studied, 4.6% had CVD; 3.1% had delivered a term low-birth-weight infant (TLBWI). Women with a history of TLBWI had an adjusted odds ratio (AOR) of 2.07 (95% confidence intervals [CI] 1.08 to 3.99) for CVD compared with women without a history of LBWI. Adjustment for hypertension and high cholesterol mildly attenuated the association (AOR 1.85, 95% CI 0.89 to 3.83). Among women without CVD (n = 4555), 23.1% with a history of TLBWI had two risk factors compared with 14.0% of those without a history of LBWI (p = 0.0016).

Conclusion Women with a history of TLBWI should be informed of a possible increased risk of CVD and encouraged to receive screenings as recommended.

Keywords

low birth weight - fetal growth - cardiovascular disease - preterm

• References

• 1 Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Mathews TJ, Osterman MJ. Births: final data for 2008. Natl Vital Stat Rep 2010; 59: 1-19 , 3–71
• 2 Lykke JA, Langhoff-Roos J, Lockwood CJ, Triche EW, Paidas MJ. Mortality of mothers from cardiovascular and non-cardiovascular causes following pregnancy complications in first delivery. Paediatr Perinat Epidemiol 2010; 24: 323-330
• 3 Pell JP, Smith GC, Walsh D. Pregnancy complications and subsequent maternal cerebrovascular events: a retrospective cohort study of 119,668 births. Am J Epidemiol 2004; 159: 336-342
• 4 Smith GD, Whitley E, Gissler M, Hemminki E. Birth dimensions of offspring, premature birth, and the mortality of mothers. Lancet 2000; 356: 2066-2067
• 5 Smith GC, Pell JP, Walsh D. Pregnancy complications and maternal risk of ischaemic heart disease: a retrospective cohort study of 129,290 births. Lancet 2001; 357: 2002-2006
• 6 Smith GD, Sterne J, Tynelius P, Lawlor DA, Rasmussen F. Birth weight of offspring and subsequent cardiovascular mortality of the parents. Epidemiology 2005; 16: 563-569
• 7 Davey Smith G, Hyppönen E, Power C, Lawlor DA. Offspring birth weight and parental mortality: prospective observational study and meta-analysis. Am J Epidemiol 2007; 166: 160-169
• 8 Li CY, Chen HF, Sung FC , et al. Offspring birth weight and parental cardiovascular mortality. Int J Epidemiol 2010; 39: 1082-1090
• 9 Bukowski R, Davis KE, Wilson PWF. Delivery of a small for gestational age infant and greater maternal risk of ischemic heart disease. PLoS ONE 2012; 7: e33047
• 10 Lykke JA, Langhoff-Roos J, Sibai BM, Funai EF, Triche EW, Paidas MJ. Hypertensive pregnancy disorders and subsequent cardiovascular morbidity and type 2 diabetes mellitus in the mother. Hypertension 2009; 53: 944-951
• 11 Catov JM, Newman AB, Roberts JM , et al; Health ABC Study. Preterm delivery and later maternal cardiovascular disease risk. Epidemiology 2007; 18: 733-739
• 12 Romundstad PR, Magnussen EB, Smith GD, Vatten LJ. Hypertension in pregnancy and later cardiovascular risk: common antecedents?. Circulation 2010; 122: 579-584
• 13 Catov JM, Wu CS, Olsen J, Sutton-Tyrrell K, Li J, Nohr EA. Early or recurrent preterm birth and maternal cardiovascular disease risk. Ann Epidemiol 2010; 20: 604-609
• 14 Nardi O, Zureik M, Courbon D, Ducimetière P, Clavel-Chapelon F. Preterm delivery of a first child and subsequent mothers' risk of ischaemic heart disease: a nested case-control study. Eur J Cardiovasc Prev Rehabil 2006; 13: 281-283
• 15 Risnes KR, Vatten LJ, Baker JL , et al. Birthweight and mortality in adulthood: a systematic review and meta-analysis. Int J Epidemiol 2011; 40: 647-661
• 16 Fraser A, Nelson SM, Macdonald-Wallis C , et al. Associations of pregnancy complications with calculated cardiovascular disease risk and cardiovascular risk factors in middle age: the Avon Longitudinal Study of Parents and Children. Circulation 2012; 125: 1367-1380
• 17 Kuklina EV, Yoon PW, Keenan NL. Prevalence of coronary heart disease risk factors and screening for high cholesterol levels among young adults, United States, 1999–2006. Ann Fam Med 2010; 8: 327-333
• 18 Rifas-Shiman SL, Forman JP, Lane K, Caspard H, Gillman MW. Diabetes and lipid screening among patients in primary care: a cohort study. BMC Health Serv Res 2008; 8: 25
• 19 Carson AP, Reynolds K, Fonseca VA, Muntner P. Comparison of A1C and fasting glucose criteria to diagnose diabetes among U.S. adults. Diabetes Care 2010; 33: 95-97
• 20 Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey Laboratory Protocol. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 1999–2006
• 21 Bernert Jr JT, Turner WE, Pirkle JL , et al. Development and validation of sensitive method for determination of serum cotinine in smokers and nonsmokers by liquid chromatography/atmospheric pressure ionization tandem mass spectrometry. Clin Chem 1997; 43: 2281-2291
• 22 Benowitz NL, Bernert JT, Caraballo RS, Holiday DB, Wang J. Optimal serum cotinine levels for distinguishing cigarette smokers and nonsmokers within different racial/ethnic groups in the United States between 1999 and 2004. Am J Epidemiol 2009; 169: 236-248
• 23 Robbins CL, Dietz PM, Bombard JM, Gibbs F, Ko JY, Valderrama AL. Blood pressure and cholesterol screening prevalence among U.S. women of reproductive age opportunities to improve screening. Am J Prev Med 2011; 41: 588-595
• 24 Bukowski R, Smith GC, Malone FD , et al; FASTER Research Consortium. Fetal growth in early pregnancy and risk of delivering low birth weight infant: prospective cohort study. BMJ 2007; 334: 836
• 25 Smith GC, Smith MF, McNay MB, Fleming JE. First-trimester growth and the risk of low birth weight. N Engl J Med 1998; 339: 1817-1822
• 26 Mook-Kanamori DO, Steegers EA, Eilers PH, Raat H, Hofman A, Jaddoe VW. Risk factors and outcomes associated with first-trimester fetal growth restriction. JAMA 2010; 303: 527-534
• 27 Magnussen EB, Vatten LJ, Myklestad K, Salvesen KA, Romundstad PR. Cardiovascular risk factors prior to conception and the length of pregnancy: population-based cohort study. Am J Obstet Gynecol 2011; 204: 526 , e1–e8
• 28 Ness RB, Sibai BM. Shared and disparate components of the pathophysiologies of fetal growth restriction and preeclampsia. Am J Obstet Gynecol 2006; 195: 40-49
• 29 Jaspers M, de Meer G, Verhulst FC, Ormel J, Reijneveld SA. Limited validity of parental recall on pregnancy, birth, and early childhood at child age 10 years. J Clin Epidemiol 2010; 63: 185-191
• 30 O'Sullivan JJ, Pearce MS, Parker L. Parental recall of birth weight: how accurate is it?. Arch Dis Child 2000; 82: 202-203
• 31 Yawn BP, Suman VJ, Jacobsen SJ. Maternal recall of distant pregnancy events. J Clin Epidemiol 1998; 51: 399-405
• 32 Sanderson M, Williams MA, White E , et al. Validity and reliability of subject and mother reporting of perinatal factors. Am J Epidemiol 1998; 147: 136-140
• 33 Curb JD, McTiernan A, Heckbert SR , et al; WHI Morbidity and Mortality Committee. Outcomes ascertainment and adjudication methods in the Women's Health Initiative. Ann Epidemiol 2003; 13 (9, Suppl) S122-S128
• 34 Irgens HU, Reisaeter L, Irgens LM, Lie RT. Long term mortality of mothers and fathers after pre-eclampsia: population based cohort study. BMJ 2001; 323: 1213-1217
• 35 Mosca L, Benjamin EJ, Berra K , et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women—2011 update: a guideline from the American Heart Association. Circulation 2011; 123: 1243-1262