Postpartum haemorrhage and risk of cardiovascular disease in later life:
A Scottish population-based record linkage cohort study
Abstract
Objective To investigate the association between postpartum
haemorrhage (PPH) and subsequent cardiovascular disease. Design
Population-based retrospective cohort study, using record linkage
between Aberdeen Maternity and Neonatal Databank (AMND) and Scottish
healthcare datasets Setting Grampian region, Scotland
Population or Sample 70,904 women who gave birth after 24 weeks
of gestation, 1986-2016 Methods We used extended Cox regression
models to investigate the association between PPH in any first or later
births and subsequent cardiovascular disease, adjusted for
sociodemographic, medical, and pregnancy and birth-related factors.
Main outcome measures Cardiovascular disease identified from
prescription of selected cardiovascular medications, hospital discharge
records or death from cardiovascular disease. Results Compared
with not having a PPH, having at least one PPH was associated with an
increased risk of developing cardiovascular disease in the first year
after birth [adjusted hazard ratio (aHR) 1.96, 95% confidence
interval (CI) 1.51-2.53, p<0.001]. The association was
attenuated over time, but strong evidence of increased risk remained 2-5
years (aHR 1.19, 95% CI 1.11-1.30, p<0.001) and 6-15 years
after giving birth (aHR 1.17, 95% CI 1.05-1.30, p=0.005), with the
direction of association reversed beyond 15 years (aHR 0.64, 95% CI
0.55-0.75, p<0.001). Conclusions Compared with women
who have never had a PPH, women who have had at least one episode of PPH
are twice as likely to develop cardiovascular disease in the first year
after birth and some increased risk persists for up to 15 years.
Keywords Postpartum haemorrhage, cardiovascular disease, health
outcomes, Scottish data