SAN FRANCISCO – Primary care providers should ask women if they have experienced placental abruption during pregnancy as this complication sharply increases the risk of cardiovascular mortality, finds a population-based cohort study of 47,918 women delivering in Israel.
Placental abruption was rare, seen in just 1.3% of the women, presenting author Dr. Eyal Sheiner reported at the annual meeting of the Society for Maternal-Fetal Medicine.
Susan London/IMNG Medical Media
Dr. Eyal Sheiner
However, with a median follow-up of about 15 years, these women had a significant near quintupling of the risk of cardiovascular death when compared with their peers who had not experienced that pregnancy complication.
Main results showed that after adjustment for potential confounders, women who had experienced placental abruption had sharply higher odds of cardiovascular death during follow-up (odds ratio, 4.8; P = .01), reported Dr. Sheiner.
Abruption did not significantly increase the adjusted odds of simple cardiovascular events or complex cardiovascular events, although there were trends in that direction.
"We all know that we can’t ignore pregnancy and say, ‘Okay, this patient had abruption, but she’s healthy,’ " he said in an interview. "Pregnancy is part of the lifetime of the patient, and if you want to reduce the [cardiovascular] risk, you have to ask about the complications during pregnancy."
"It’s very easy – it’s not that I am telling them to do something invasive. But I’m telling family practitioners to ask about pregnancy complications. It’s just a single question, and it’s part of the risk assessment," he added.
Dr. Sheiner hastened to point out that absolute rates of cardiovascular death among the women studied were low: 0.3% in the group with and 0.1% in the group without placental abruption.
"My aim is not to stress patients," he said, but rather to convey the importance of asking specifically about this complication.
The 2011 guidelines of the American Heart Association mention the importance of asking about other pregnancy complications during cardiovascular risk assessment, according to Dr. Sheiner, professor of obstetrics and gynecology and director of the maternity department at Soroka University Medical Center in Beer-Sheva, Israel.
"In their report, they recommend that all women should be asked about pregnancy-induced hypertension and diabetes. So we were thinking about other complications that might be risk factors for subsequent complications," he explained.
Specifically, "we wanted to see if placental abruption might serve as a trigger for long-term cardiovascular events because placental abruption has a vascular etiology, and we know that pregnancy might be considered as a stress test for things to happen."
Study analyses were based on women delivering between 1988 and 1999 at a single institution – the lone, tertiary-care hospital serving Israel’s Negev region – which permitted good long-term follow-up, he pointed out. The investigators assessed cardiovascular outcomes through 2010.
The study’s findings were reported during a poster session at the meeting.
Dr. Sheiner disclosed no relevant conflicts of interest.