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Association of Maternal Preeclampsia With Offspring Risks of Ischemic Heart Disease and Stroke in Nordic Countries

Authors :
Fen Yang
Imre Janszky
Mika Gissler
Nathalie Roos
Anna-Karin Wikström
Yongfu Yu
Hua Chen
Anna-Karin Edstedt Bonamy
Jiong Li
Krisztina D. László
Source :
JAMA Network Open, Yang, F, Janszky, I, Gissler, M, Roos, N, Wikström, A K, Yu, Y, Chen, H, Bonamy, A K E, Li, J & László, K D 2022, ' Association of Maternal Preeclampsia With Offspring Risks of Ischemic Heart Disease and Stroke in Nordic Countries ', JAMA network open, vol. 5, no. 11, e2242064 . https://doi.org/10.1001/jamanetworkopen.2022.42064
Publication Year :
2022
Publisher :
American Medical Association, 2022.

Abstract

ImportanceAn association between maternal preeclampsia and an increased risk of cardiovascular disease in the offspring is plausible, but evidence in this area is limited.ObjectiveTo investigate (1) the association between maternal preeclampsia and risks of ischemic heart disease (IHD) and stroke in the offspring, (2) whether the association varies by severity or timing of onset of preeclampsia, and (3) the role of preterm birth and small for gestational age (SGA) birth, both of which are related to preeclampsia and cardiovascular diseases, in this association.Design, Setting, and ParticipantsThis multinational population-based cohort study obtained data from Danish, Finnish, and Swedish national registries. Live singleton births from Denmark (1973-2016), Finland (1987-2014), and Sweden (1973-2014) were followed up until December 31, 2016, in Denmark and December 31, 2014, in Finland and Sweden. Data analyses were performed between September 2020 and September 2022.ExposuresPreeclampsia and its subtypes, including early onset (Main Outcomes and MeasuresDiagnoses of IHD and stroke were extracted from patient and cause-of-death registers. Cox proportional hazards regression models and flexible parametric survival models were used to analyze the associations. Sibling analyses were conducted to control for unmeasured familial factors.ResultsThe cohort included of 8 475 819 births (2 668 697 [31.5%] from Denmark, 1 636 116 [19.3%] from Finland, and 4 171 006 [49.2%] from Sweden, comprising 4 350 546 boys [51.3%]). Of these offspring, 188 670 (2.2%) were exposed to maternal preeclampsia, 7446 (0.1%) were diagnosed with IHD, and 10 918 (0.1%) were diagnosed with stroke during the median (IQR) follow-up of 19.3 (9.0-28.1) years. Offspring of individuals with preeclampsia had increased risks of IHD (adjusted hazard ratio [HR], 1.33; 95% CI, 1.12-1.58) and stroke (adjusted HR, 1.34; 95% CI, 1.17-1.52). These associations were largely independent of preterm or SGA birth. Severe forms of preeclampsia were associated with a higher stroke risk than less severe forms (severe vs mild or moderate: adjusted HR, 1.81 [95% CI, 1.41-2.32] vs 1.22 [95% CI, 1.05-1.42]; early vs late onset: adjusted HR, 2.55 [95% CI, 1.97-3.28] vs 1.18 [95% CI, 1.01-1.39]; with vs without SGA birth: adjusted HR, 1.84 [95% CI, 1.44-2.34] vs 1.25 [95% CI, 1.07-1.48]). Sibling analyses suggested that the associations were partially explained by unmeasured familial factors.Conclusions and RelevanceResults of this study suggest that offspring born to individuals with preeclampsia had increased IHD and stroke risk that were not fully explained by preterm or SGA birth, and that the associated risks for stroke were higher for severe forms of preeclampsia.

Details

Language :
English
Database :
OpenAIRE
Journal :
JAMA Network Open, Yang, F, Janszky, I, Gissler, M, Roos, N, Wikström, A K, Yu, Y, Chen, H, Bonamy, A K E, Li, J & László, K D 2022, ' Association of Maternal Preeclampsia With Offspring Risks of Ischemic Heart Disease and Stroke in Nordic Countries ', JAMA network open, vol. 5, no. 11, e2242064 . https://doi.org/10.1001/jamanetworkopen.2022.42064
Accession number :
edsair.doi.dedup.....6858f9f0cc0c863016f67503abf847f5