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History of abruption linked to 5-fold rise in CVD deaths.


SAN FRANCISCO-Placental abruption during pregnancy sharply increases the risk of cardiovascular disease mortality later in life, based on a population-based cohort study of 47,918 women who delivered babies in Israel.

Placental abruption was rare, seen in just 1.3% of the women, presenting author Dr. Eyal Sheiner reported at the annual meeting of the Society for Maternal-Fetal Medicine.

However, with a median follow-up of about 15 years, these women had a significant near quintupling of the risk of cardiovascular death when compared with their peers who had not experienced that pregnancy complication.

After adjustment for potential confounders, women who had experienced placental abruption had sharply higher odds of cardiovascular death during follow-up (odds ratio, 4.8; P = .01), reported Dr. Sheiner.

Dr. Sheiner hastened to point out that the absolute rates of cardiovascular death among the women studied were low: 0.3% in the group with and 0.1% in the group without placental abruption.

Abruption did not significantly increase the adjusted odds of simple cardiovascular events or complex cardiovascular events, although there were trends in that direction.

Dr. Sheiner emphasized that patients be made aware of their risks.

"We all know that we can't ignore pregnancy and say, 'Okay, this patient had abruption, but she's healthy,' "he-said in an interview." Pregnancy is part of the lifetime of the patient."

"I'm telling family practitioners to ask about pregnancy complications. It's just a single question, and it 's part of the risk assessment," Dr. Sheiner added.

"My aim is not to stress patients," he said, but rather to convey the importance of asking specifically about this complication.

The 2011 guidelines of the American Heart Association mention the importance of asking about other pregnancy complications during cardiovascular risk assessment, according to Dr. Sheiner, who is a professor of obstetrics and gynecology and director of the maternity department at Soroka University Medical Center in Beer-Sheva, Israel.

For the purposes of his study. Dr. Sheiner "wanted to see if placental abruption might serve as a trigger for long-term cardiovascular events because placental abruption has a vascular etiology, and we know that pregnancy might be considered as a stress test for things to happen."

Study analyses were based on women delivering between 1988 and 1999 at a single institution--the lone, tertiary-care hospital serving Israel's Ncgev region.

The records provided through this analysis permitted good long-term follow-up through 2010, he pointed out.

Dr. Sheiner disclosed that he has no relevant conflicts of interest.

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Title Annotation:OBSTETRICS
Author:London, Susan
Publication:OB GYN News
Geographic Code:1USA
Date:May 1, 2013
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