A study led by the Obstetrics and Gynaecology Service of the Vall d'Hebron University Hospital and the Maternal and Fetal Medicine group of the Vall d'Hebron Research Institute (VHIR) has shown that women who have suffered serious complications during pregnancy have a higher risk of developing cardiovascular diseases, such as stroke or heart attack, years after delivery. The results, published in the journal Healthcare, show the importance of monitoring these women to improve long-term health. The study has been carried out in collaboration with the Cardiovascular Diseases group of VHIR, the Cardiology Service of Vall d'Hebron Hospital, the Catalan Institute of Health, La Paz University Hospital, the Universitat Jaume I of Castelló and the Cardiovascular Diseases area at CIBER (CIBERCV).

The research has analysed for the first time in Spain the relationship between suffering complications in pregnancy and the risk of cardiovascular diseases, such as a heart attack or stroke, in the years following childbirth. Specifically, the study considered pre-eclampsia (related to high blood pressure during pregnancy), premature birth, gestational diabetes, miscarriages and stillbirth. "International studies have previously explored this connection and it is essential to have specific data from our population to better adapt prevention and follow-up strategies", highlights Dr. María Goya, physician at the Obstetrics and Gynaecology Department at Vall d'Hebron Hospital and principal investigator of the Maternal and Fetal Medicine group at VHIR.

The analysis is based on data from 10,734 women who delivered at Vall d'Hebron Hospital between 2010 and 2015. Of these, 8,234 had no complications during pregnancy, while 2,500 did suffer some. Subsequently, they were followed up for a period of 6 to 11 years, depending on the time of delivery, to determine the occurrence of cardiovascular diseases with the collaboration of primary care.

Women with pregnancy complications have twice the risk of strokes or heart attacks

The results showed that women who had had some kind of complication during pregnancy had a higher risk of having a stroke or heart attack years after giving birth. These occurred, on average, six years after birth.

Specifically, women with complications had a 2.5 times higher risk than women without, although the numbers were low: 12 of the 2,500 women with complications had a stroke or heart attack, while there were 13 strokes or heart attacks among the 8,234 women who did not have complications. Among the most remarkable data is that having a preterm birth is associated with a fourfold increased risk of having a stroke, and that having pre-eclampsia increases the risk of stroke or heart attack fourfold.

For women who had more than one complication during pregnancy, the risk was even higher than if they had only had one. They had eight times the risk of stroke or heart attack than women without complications.

The researchers adjusted the results for other factors that could influence the risk of cardiovascular disease, such as a woman's age, obesity or smoking, to ensure that the results reflect the direct link between complications during pregnancy and later risk.

“Pregnancy can help to detect early potential cardiovascular health problems that will occur later in life”, highlights Dr. Marta Miserachs, first author of the work carried out at Vall d'Hebron and current assistant of Gynaecology and Obstetrics at Mútua Terrassa. “It is an opportunity to follow up more closely women who have had complications during pregnancy and implement measures to prevent cardiovascular disease after delivery, with the aim of reducing long-term risks”, adds Cristina Martínez, head of the Barcelona City Sexual and Reproductive Health Care Programme of the Catalan Health Institute (ICS).

From now on, “a specific postpartum follow-up circuit will be created for these women at Vall d'Hebron, in collaboration with Primary Care. In addition, we will offer those who wish to participate in a clinical trial using more proactive interventions to reduce the cardiovascular risk of these women”, explains Dr. Goya.

More research to understand the reasons for this relationship

During pregnancy, a woman's body needs to adapt to provide energy for herself and the foetus. This is done through changes in metabolism, the heart and blood vessels that, while necessary, can worsen underlying conditions and translate into alterations in gestation. "Pregnancy is considered a stress test that reveals vulnerabilities in the woman's cardiovascular system that may have gone unnoticed until then", explains Dr. Antonia Pijuan, physician at the Cardiology Department at Vall d’Hebron University Hospital and researcher in the Cardiovascular Diseases group at VHIR and CIBERCV.

The authors of the paper stress the importance of further research to understand the relationship between gestational and cardiovascular complications and why heart attacks and strokes occur in the long term.