Premature cardiac disease and death in women whose infant was preterm and small for gestational age: a retrospective cohort study

Importance — Women with an infant with preterm birth (PTB) or who was severely small for gestational age (SGA) are at higher future risk of premature cardiovascular disease and related death.

Objective — To determine the risk of cardiac disease or death among women with an infant with both PTB and SGA.

Design, Setting, and Participants — This population-based cohort study used electronic health records from the province of Ontario, Canada, where healthcare is universally available, between April 1, 2002, and March 31, 2016. All singleton live births between 23 to 42 weeks' gestation among 710 501 nulliparous women aged 16 to 50 years without prepregnancy cardiac disease were analyzed.

Main Outcomes and Measures — Risk of a composite outcome of heart failure, atrial or ventricular dysrhythmia, or all-cause mortality, starting 30 days after the index birth. Hazard ratios were adjusted for maternal age, income quintile, and preeclampsia/eclampsia (each at the index birth), as well as diabetes, chronic hypertension, obesity, dyslipidemia, drug dependence or smoking, and kidney disease (each within 24 months before the index birth date and time-varying from the birth date onward).

Results — Of 710,501 singleton live births, 15,082 mothers (2.1%) were older than age 40 years. Relative to having an infant without PTB or severe SGA (4.1 per 10 000 person-years), the incidence rate of the composite outcome of heart failure, dysrhythmia, or death was 11.3 per 10,000 person-years among mothers with an infant with PTB-SGA (crude hazard ratio, 2.79; 95% CI, 1.85-4.21) (adjusted hazard ratio, 1.66; 95% CI, 1.09-2.52).

Conclusions and Relevance — Women who had an infant with PTB-SGA may be at higher future risk of premature cardiac disease or death.