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Synergistic Effects of Maternal Atherosclerotic Cardiovascular Disease and Adverse Pregnancy Outcomes: A Nationwide Mother-Child Cohort Study
Background: This study aimed to determine the association between maternal pre-existing atherosclerotic cardiovascular disease(ASCVD) and adverse pregnancy outcomes(APOs), and to check their combined effect on the cardiovascular risk of women’s life after childbirth and long-term outcomes of offsprings.
Methods: A retrospective mother-child cohort study of pregnant women with live births from January 2005 and December 2019 was conducted using nationwide Korean claim database. Women were matched using a large-scale propensity score algorithm according to pre-existing ASCVD(defined as angina pectoris, myocardial infarction, and ischemic stroke) before pregnancy. The maternal primary outcome was major adverse cardiac and cerebrovascular events(MACCE, a composite of all-cause death, myocardial infarction, revascularization, and stroke). For offspring, infant outcomes including chromosomal abnormalities, major congenital malformations, neonatal composite morbidities, and long-term neurodevelopmental disorders were assessed. This study is registered with ClinicalTrials.gov, NCT06406998.
Findings: Among the total cohort(n=5461222), 2.7% of women(n=145315) had pre-existing ASCVD before pregnancy. The prevalence of pre-existing ASCVD tended to increase over time(p<0·001). After 1:4 matching, 726575 pairs were generated(mean-age=33·3years). Pre-existing ASCVD and preterm birth(without pre-existing ASCVD/preterm birth vs. with pre-existing ASCVD/preterm birth,HR:4·13,95%CI:3·91–4·36) and preeclampsia or eclampsia(without pre-existing ASCVD/preeclampsia or eclampsia vs. with pre-existing ASCVD/preeclampsia or eclampsia,HR:4·07,95%CI:3·69–4·48) manifested synergistic effect on MACCE. Offspring of women with pre-existing ASCVD were associated with higher risk for major congenital malformations, neonatal composite morbidities, and long-term neurodevelopmental disorders, regardless of APOs.
Interpretation: Analyses from a large national cohort with mother-child pairs revealed that pregnant women with pre-existing ASCVD and APO had a synergistic effect on maternal MACCE after childbirth.
Keywords: atherosclerotic cardiovascular disease, pregnancy, adverse pregnancy outcomes, adverse birth outcomes, major adverse cardiac and cerebrovascular events
Choi, Ki Hong and Heo, Jihye and Kang, Danbee and Park, Taegyun and Sung, Ji-Hee and Park, Taek Kyu and Lee, Joo Myung and Cho, Juhee and Yang, Jeong Hoon and Song, Young Bin and Hahn, Joo-Yong and Choi, Seung-Hyuk and Gwon, Hyeon-Cheol and Oh, Soo-Young, Synergistic Effects of Maternal Atherosclerotic Cardiovascular Disease and Adverse Pregnancy Outcomes: A Nationwide Mother-Child Cohort Study. Available at SSRN: https://ssrn.com/abstract=5172443 or http://dx.doi.org/10.2139/ssrn.5172443
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