Journal Article

Pregnancy Complications and Subsequent Maternal Cerebrovascular Events: A Retrospective Cohort Study of 119,668 Births

Jill P. Pell, Gordon C. S. Smith and David Walsh

in American Journal of Epidemiology

Published on behalf of Johns Hopkins Bloomberg School of Public Health

Volume 159, issue 4, pages 336-342
Published in print February 2004 | ISSN: 0002-9262
Published online February 2004 | e-ISSN: 1476-6256 | DOI: http://dx.doi.org/10.1093/aje/kwh064
Pregnancy Complications and Subsequent Maternal Cerebrovascular Events:  A Retrospective Cohort Study of 119,668 Births

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Low birth weight infants are at increased risk of cerebrovascular disease in adulthood. This has been attributed to physiologic programming following inadequate intrauterine nutrition. The authors sought to determine whether mothers who deliver low birth weight infants or who suffer related pregnancy complications are also at increased risk. They used routine data to identify all first singleton livebirths in Scotland (1981–1985) and found that 342 of the 119,668 mothers suffered cerebrovascular events over 14–19 years’ follow-up. Compared with women who delivered babies of ≥3,500 g, women who delivered low birth weight (<2,500 g) infants were at increased risk of cerebrovascular disease (adjusted hazards ratio (HR) = 2.51, 95% confidence interval (CI): 1.71, 3.70) with a consistent trend across birth weight categories. The lowest birth weight quintile (adjusted HR = 1.29, 95% CI: 1.01, 1.65), preterm delivery (adjusted HR = 1.91, 95% CI: 1.35, 2.70), and previous spontaneous abortion (adjusted HR = 1.49, 95% CI: 1.09, 2.03) were all predictive of subsequent maternal cerebrovascular events. The effects were additive. Women who experienced all three complications had a sevenfold risk (adjusted HR = 7.03, 95% CI: 2.24, 22.06). The association with low birth weight in mothers, as well as offspring, is unlikely to be explained by intrauterine programming and suggests that cerebrovascular disease and low birth weight may share common genetic or lifestyle risk factors.

Keywords: abortion, spontaneous; cerebrovascular accident; fetal growth retardation; gestational age; labor, premature; pre-eclampsia; Abbreviations: CI, confidence interval; HR, hazards ratio; ICD-9, International Classification of Diseases, Ninth Revision; ICD-10, International Classification of Diseases, Tenth Revision; SMR, Scottish Morbidity Record.

Journal Article.  4100 words.  Illustrated.

Subjects: Public Health and Epidemiology

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