Volume 127, Issue 12 p. 1489-1497
Epidemiology

Obstetric haemorrhage and risk of cardiovascular disease after three decades: a population-based cohort study

UV Ukah

UV Ukah

Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada

Institut national de santé publique du Québec, Montreal, QC, Canada

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RW Platt

RW Platt

Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada

Department of Paediatrics, McGill University, Montreal, QC, Canada

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BJ Potter

BJ Potter

Cardiology Service, University of Montreal Hospital Centre, Montreal, QC, Canada

University of Montreal Hospital Research Centre, Montreal, QC, Canada

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G Paradis

G Paradis

Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada

Institut national de santé publique du Québec, Montreal, QC, Canada

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N Dayan

N Dayan

Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada

Department of Medicine, Department of Obstetrics and Gynaecology, McGill University Health Centre, Montreal, QC, Canada

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S He

S He

Institut national de santé publique du Québec, Montreal, QC, Canada

University of Montreal Hospital Research Centre, Montreal, QC, Canada

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N Auger

Corresponding Author

N Auger

Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada

Institut national de santé publique du Québec, Montreal, QC, Canada

University of Montreal Hospital Research Centre, Montreal, QC, Canada

Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada

Correspondence: Dr N Auger, University of Montreal Hospital Research Centre, 900 rue St-Denis, Montreal, QC H2X 0A9, Canada. Email: [email protected]

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First published: 16 May 2020
Citations: 10
Linked article: This article is commented on by LH Theilen, p. 1498 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.16354.

Abstract

Objective

To investigate the association between obstetric haemorrhage and cardiovascular disease up to three decades after pregnancy.

Design

Population-based cohort study.

Setting and population

All women who delivered between 1989 and 2016 in Quebec, Canada.

Methods

Using hospital admissions data, 1 224 975 women were followed from their first delivery until March 2018. The main exposure measures were antenatal (placenta praevia, placental abruption, peripartum haemorrhage) or postpartum haemorrhage, with or without transfusion. Adjusted Cox regression models were used to assess the association between obstetric haemorrhage and future cardiovascular disease.

Main outcome measure

Cardiovascular hospitalisation.

Results

Among 104 291 (8.5%) women with haemorrhage, 4612 (4.4%) required transfusion. Women with haemorrhage had a higher incidence of cardiovascular hospitalisation than women without haemorrhage (15.5 versus 14.1 per 10 000 person-years; 2437 versus 28 432 events). Risk of cardiovascular hospitalisation was higher for obstetric haemorrhage, with or without transfusion, compared with no haemorrhage (adjusted hazard ratio [aHR] 1.06, 95% CI 1.02–1.10). Women with haemorrhage and transfusion had a substantially greater risk of cardiovascular hospitalisation (aHR 1.47, 95% CI 1.23–1.76). Among transfused women, placental abruption (aHR 1.79, 95% CI 1.06–3.00) and postpartum haemorrhage (aHR 1.38, 95% CI 1.13–1.68) were both associated with risk of cardiovascular hospitalisation. Antenatal haemorrhage with transfusion was associated with 2.46 times the risk of cardiovascular hospitalisation at 5 years (95% CI 1.59–3.80) and 2.14 times the risk at 10 years (95% CI 1.47–3.12).

Conclusions

Obstetric haemorrhage requiring transfusion is associated with maternal cardiovascular disease. The benefit of cardiovascular risk prevention in pregnant women with obstetric haemorrhage requires further investigation.

Tweetable abstract

Risk of future cardiovascular disease is increased for women with obstetric haemorrhage who require transfusion.