Pregnancy complications and long-term risk of maternal aortic valve stenosis and disease severity
M Freysteinsdottir, E Taufer Cederlof, E Lampa, C ChristerssonAbstract
Background
Pregnancy complications are established risk factors for long-term maternal cardiovascular disease, particularly coronary artery disease (CAD). However, their association with aortic valve stenosis (AS) remains unknown.
Purpose
To investigate whether pregnancy complications are associated with increased long-term maternal risk of AS and with severe AS requiring valve intervention, with or without concomitant severe CAD.
Methods
In this nationwide population-based cohort study, 2,012,327 women with singleton pregnancies recorded in the Swedish Medical Birth Register between 1973 and 2020 were included, excluding women with major comorbidities and incomplete pregnancy data. Pregnancy complications included preeclampsia (PE), gestational hypertension (GHT), gestational diabetes (GDM), small for gestational age (SGA) and stillbirth. Outcomes were incident AS and aortic valve intervention with or without concomitant coronary artery intervention, identified through linkage to the National Patient register, National Cause of Death register and the SWEDEHEART registry. Women were followed from first delivery until death or end of follow-up. Associations between recurrent pregnancy complications and AS risk were also assessed.
Results
During follow-up, 4,177 women (8.8 per 100,000 person-years) were diagnosed with AS. PE was associated with increased AS risk compared with no pregnancy complications, with a stronger association observed after recurrent PE (hazard ratio [HR] 1.30, 95% CI 1.07–1.57 for 1 affected pregnancy; HR 1.68, 95% CI 1.08–2.59 for ≥2 pregnancies). GHT was associated with increased AS risk after one affected pregnancy without further risk increase with recurrence (1 pregnancy HR 1.85, 95% CI 1.50–2.28, HR 1.68, 95% CI 0.93–3.05 for ≥2 pregnancies). SGA was associated with elevated risk after recurrent exposure (HR 1.64, 95% CI 1.01–2.67 for ≥2 pregnancies). No significant associations were observed for GDM or stillbirth. Pregnancy complications were not associated with isolated aortic valve intervention; however, PE was associated with increased risk of combined aortic valve and coronary intervention (odds ratio 2.22, 95% CI 1.30–3.79).
Conclusions
PE, GHT or SGA were associated with increased long-term maternal risk of AS, with the highest risk observed after recurrent PE. PE was also associated with more severe AS accompanied by CAD requiring intervention. These findings suggest that pregnancy complications may represent early markers of future AS and support continued cardiovascular surveillance in affected women.pregnancy complications_risk of ASpregnancy complications_interventions