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Heart failure and dysrhythmias after maternal placental syndromes: HAD MPS Study
  1. Joel G Ray1,2,3,
  2. Michael J Schull4,5,
  3. John C Kingdom6,7,8,
  4. Marian J Vermeulen9
  1. 1Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
  2. 2Department of Health Policy Management and Evaluation, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
  3. 3Department of Obstetrics and Gynecology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
  4. 4Division of Emergency Medicine, Department of Medicine, Sunnybrook and Women's College Health Sciences Centre, Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada
  5. 5Department of Health Policy Management and Evaluation, Sunnybrook and Women's College Health Sciences Centre, Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada
  6. 6Placenta Clinic, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Ontario, Ontario, Canada
  7. 7Division of Maternal-Fetal Medicine, Department of Pathology, Mount Sinai Hospital, University of Toronto, Ontario, Ontario, Canada
  8. 8Division of Maternal-Fetal Medicine, Department of Medical Imaging, Mount Sinai Hospital, University of Toronto, Ontario, Ontario, Canada
  9. 9Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Joel G Ray, Department of Medicine, St Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada; rayj{at}smh.ca

Abstract

Background Maternal placental syndromes (MPS)—gestational hypertension, pre-eclampsia and placental abruption/infarction—are more prevalent in women with features of the metabolic syndrome (MetSyn). Both MPS and the MetSyn predispose to left ventricular impairment and sympathetic dominance after delivery. Whether this translates into a higher risk of heart failure (HF) and cardiac dysrhythmias is not known.

Objective To determine the risk of new onset of HF and dysrhythmias among women after a prior MPS-affected pregnancy.

Methods A retrospective cohort study was carried out of 1 130 764 individual women with a delivery in Ontario between 1992 and 2009, excluding those with cardiac or thyroid disease 1 year before delivery. The risk of a composite outcome of a hospitalisation for HF or an atrial or ventricular dysrhythmia was compared in women with and without MPS, starting 1 year after delivery.

Results 75 242 individuals (6.7%) experienced a MPS. After a median duration of 7.8 years, the composite outcome occurred in 148 women with MPS (2.54 per 10 000 person-years) and 1062 women without MPS (1.28 per 10 000 person-years) (crude HR=2.00, 95% CI 1.68 to 2.38). The mean age at composite outcome was 37.8 years. The HR was 1.61 (95% CI 1.35 to 1.91) after adjustment for demographic characteristics, diabetes, obesity, dyslipidaemia and drug dependence or tobacco use, as well as coronary artery disease or thyroid disease >1 year after delivery. The adjusted HRs were minimally reduced by further adjusting for chronic hypertension (1.51, 95% CI 1.26 to 1.80) and were higher in women with MPS plus preterm delivery and poor fetal growth (2.42, 95% CI 1.25 to 4.67).

Conclusions Women with MPS are at higher risk of premature HF and dysrhythmias, especially when perinatal morbidity is present.

  • Atrial dysrhythmia
  • atrial fibrillation
  • atrial flutter
  • ventricular dysrhythmia
  • heart failure
  • gestational hypertension
  • preeclampsia
  • abruption
  • infarction
  • placenta
  • metabolic syndrome
  • hypertension
  • deep vein thrombosis
  • homocysteine

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Footnotes

  • See Editorial, p 1109

  • This study was supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred.

  • Funding Funded by the Institute of Human Development, Child and Youth Health, Canadian Institutes of Health Research.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by Sunnybrook Health Sciences Centre.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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