Obstetric hemorrhage and risk of cardiovascular disease after three decades: A population-based cohort study.

OBJECTIVE: To investigate the association between obstetric hemorrhage 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 previa, placental abruption, peripartum hemorrhage) or postpartum hemorrhage, with or without transfusion. Adjusted Cox regression models were used to assess the association between obstetric hemorrhage and future cardiovascular disease. MAIN OUTCOME MEASURE: Cardiovascular hospitalization RESULTS: Among 104,291 (8.5%) women with hemorrhage, 4612 (4.4%) required transfusion. Women with hemorrhage had a higher incidence of cardiovascular hospitalization than women without hemorrhage (15.5 vs. 14.1 per 10,000 person-years; 2437 vs. 28,432 events). Risk of cardiovascular hospitalization was higher for obstetric hemorrhage, with or without transfusion, compared with no hemorrhage (aHR 1.06, 95% CI 1.02-1.10). Women with hemorrhage and transfusion had a substantially greater risk of cardiovascular hospitalization (aHR 1.47, 95% CI 1.23-1.76). Among transfused patients, placental abruption (aHR 1.79, 95% CI 1.06-3.00) and postpartum hemorrhage (aHR 1.38, 95% CI 1.13-1.68) were both associated with risk of cardiovascular hospitalization. Antenatal hemorrhage with transfusion was associated with 2.46 times the risk of cardiovascular hospitalization 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 hemorrhage requiring transfusion is associated with maternal cardiovascular disease. The benefit of cardiovascular risk prevention in pregnant women with obstetric hemorrhage requires further investigation. FUNDING: Heart & Stroke Foundation of Canada (G-18-0021776) and Fonds de recherche Quebec-Sante (34695).