Placental Abruption May Be Associated With an Increased Risk for Heart Failure

Placental abruption may be associated with an increased risk for heart failure, particularly among women with hypertensive disorders of pregnancy and preterm birth, according to study results published in the American Journal of Cardiology.

A growing body of evidence suggests that complications during pregnancy are associated with an increased risk for cardiovascular disease. Using data from the California Healthcare Cost and Utilization Project (HCUP) database, investigators aimed to determine whether there is an association between placenta abruption, one of the most severe placental vascular events, and risk for myocardial infarction, stroke, or heart failure.

Data from over 1.5 million women were included in the analysis, which represented a diverse population (39.0% Hispanic; 38.9% White; 12.2% Asian/Pacific Islander; 6.5% Black). Placental abruption occurred in 14,881 pregnancies (1%). A total of 8,724 women developed a CVD outcome over the course of follow-up (median, 4.87 years), including 480 instances of myocardial infarction, 1353 strokes, and 2143 instances of heart failure.

In this cohort, there were 0.66, 1.84, and 2.98 cases of myocardial infarction, stroke, and heart failure per 10,000 person-years, respectively. In women with placental abruption, these rates increased to 2.69 and 7.19 cases of stroke and heart failure per 10,000 person-years, respectively.

Placental abruption was found to be associated with a risk for heart failure (hazard ratio [HR], 2.45; 95% CI, 1.86-3.23), but not myocardial infarction or stroke in a univariate analysis. This association was attenuated after adjusting for pregnancy-related conditions (HR, 1.97; 95% CI, 1.49-2.61), but remained significant after accounting for all covariates considered (HR, 1.44; 95% CI, 1.09-1.90).

There was a significant interaction between placental abruption and hypertensive disorders during pregnancy on the risk for heart failure (P <.05). Among women with a composite of hypertensive disorders (gestational hypertension, pre-eclampsia, and eclampsia, placental abruption was associated with a higher risk for heart failure (HR, 1.79; 95% CI, 1.30-2.48) compared with those without hypertensive disorders (HR, 0.90; 95% CI, 0.52-1.60).

After adjusting for preterm birth, the association between placental abruption and heart failure was attenuated (HR, 1.21; 95% CI, 0.91-1.61).

“Women with placental abruptions should be considered at risk [for heart failure], especially if they also experience other pregnancy-related conditions such as hypertensive disorders of pregnancy and/or preterm birth,” the study authors concluded. “An appreciation for the link between pregnancy-related conditions and [heart failure] could allow for early identification and risk factor modification of women at high-risk.”

Reference

DesJardin JT, Healy MJ, Nah G, et al. Placental abruption as a risk factor for heart failure [published online June 30, 2020]. The American Journal of Cardiology. doi: 10.1016/j.amjcard.2020.06.034