Cardiovascular Disease in Women the Two Decades Following Uteroplacental Disorders: A Population‐Based Data‐Linkage Study

OBJECTIVE: Uniform recommendations on cardiovascular follow-up after complicated pregnancies are lacking, partly due to limited evidence. This study aimed to investigate the incidence and timing of premature cardiovascular disease (CVD) after different uteroplacental disorders, to inform the timing and content of cardiovascular follow-up. DESIGN: Population-based cohort study, linking data from the Dutch perinatal registry with national hospital admissions data. SETTING: Netherlands, 2000-2022. POPULATION: 1 669 681 nulliparous women, with a singleton pregnancy. METHODS: Cox regression was used to estimate hazard ratios for overall CVD and specific cardiovascular conditions after uteroplacental disorders, adjusted for confounders. Time-dependent Cox regression and interaction analyses for education attainment, income, and migration background were performed. RESULTS: Risks of premature hypertension, atherosclerosis, ischaemic heart disease, cardiac arrest, cardiomyopathy, heart failure, and cerebrovascular disease were significantly increased among women with a history of a uteroplacental disorder, adjusted for confounders (overall CVD: aHR 1.70, 95% CI 1.67-1.74; median follow-up time 11 years, IQR 6-17 years). Hazard ratios were similar after pregnancy induced hypertension (PIH), preeclampsia (PE), fetal growth restriction (FGR), or fetal death, while risks after spontaneous preterm birth (sPTB) were less elevated. Most relative CVD risks were highest shortly after pregnancy but remained elevated more than 10 years postpartum. After hypertensive disorders of pregnancy (HDP), hypertension risk was most pronounced, whereas after FGR the increased risk of atherosclerosis was most notable. Socioeconomic factors had limited impact on these associations. CONCLUSIONS: All uteroplacental disorders-not only PE-serve as women-specific markers of CVD risk, shortly after pregnancy and later in life, highlighting the need for early cardiovascular screening. Pathological processes contributing to the increased CVD risk might differ across uteroplacental disorders.