(773) Adverse pregnancy outcomes and the development of short-term maternal cardiovascular disease risk factors

Retrospective cohort study of patients who delivered from January 2016 until December 2020 in two health care systems with at least one pre-delivery and one postpartum appointment who were free of CVD and outcomes of interest at baseline. The first eligible pregnancy in the study period served as the index pregnancy. APOs were defined using ICD-10 codes for gestational hypertension, preeclampsia, gestational diabetes, preterm delivery, and delivery of a small for gestational age infant. Patients were followed until December 2021 for the development of CVD risk factors after delivery hospitalization (chronic hypertension, hyperlipidemia, type 2 diabetes, prediabetes; defined by ICD-10 codes). The crude cumulative hazard for CVD risk factors was estimated at three and five years after delivery.

Results: One quarter of patients (25.7%; 14,482 of 56,317) had ≥1 APO. Median length of follow-up was 1.9 years (interquartile range: 0.8-3.3). Among those with an APO, 18.1% developed a CVD risk factor after delivery compared to 6.7% of patients without an APO (Table). Among those who were followed for the full year after delivery, 7.7% of patients with an APO developed a CVD risk factor within 1 year. The estimated cumulative hazard of developing a CVD risk factor after APO pregnancy was 21.7% three years after delivery and 54.3% five years after delivery (Figure). Patients with an APO were most likely to develop chronic hypertension after delivery, except for those with gestational diabetes who were more likely to develop type 2 diabetes.

Conclusion: In this high-risk population, patients with an APO had a multifold risk of developing CVD risk factors in the short-term following their delivery compared to those without an APO.