Growth restriction and stillbirth carry the same heart signal as pre-eclampsia

Design

Population-based registry linkage cohort, Netherlands 2000–2022

Population

1,669,681 nulliparous women with a singleton pregnancy

Primary outcome

Premature cardiovascular disease after uteroplacental disorders

Effect

Overall CVD adjusted HR 1.70 (95% CI 1.67–1.74); median follow-up 11 years

Dutch investigators linked the national perinatal registry to hospital admissions for 1,669,681 nulliparous women with a singleton pregnancy between 2000 and 2022. Median follow-up was 11 years. They compared premature cardiovascular disease in women with and without a uteroplacental disorder, adjusting for confounders.

Any uteroplacental disorder was associated with a 70% higher hazard of cardiovascular disease. The hazard ratios were similar whether the index pregnancy had gestational hypertension, pre-eclampsia, fetal growth restriction or a fetal death; spontaneous preterm birth carried a smaller excess. Relative risk was highest in the years soon after delivery and remained raised more than a decade later. Hypertension dominated after hypertensive disorders, while atherosclerosis stood out after growth restriction. Education, income and migration background changed the associations little.

Most postnatal cardiovascular follow-up, where it exists, is triggered by pre-eclampsia alone. This cohort suggests growth restriction and fetal death belong on the same list. Recording these outcomes clearly in the discharge summary, and passing them to the woman's GP or physician, costs nothing and lets blood pressure, lipids and glucose be checked on time.

• Record fetal growth restriction, fetal death and gestational hypertension in the discharge summary as cardiovascular risk markers, not only pre-eclampsia
• Tell women with any of these outcomes that their future heart and blood pressure risk is raised, and why
• Hand over to primary care with a request for blood pressure, lipid and glucose checks in the first postpartum year
• Expect hypertension after hypertensive pregnancies and look for atherosclerotic risk after growth restriction
• Spontaneous preterm birth carries a smaller but real excess; mention it at the postnatal review

Why it matters

Postnatal cardiovascular follow-up built around pre-eclampsia alone misses women carrying the same risk.

Don't overread it

This is a registry association; it does not show that screening these women prevents cardiovascular events.

The statistics, in plain English

An adjusted hazard ratio of 1.70 means women with a placental complication developed cardiovascular disease at about 1.7 times the rate of comparable women without one, at any point in follow-up. The very narrow confidence interval (1.67–1.74) reflects the enormous sample, not proof of cause. Relative risks look large in young women partly because their baseline risk is low, so the absolute number of events is still modest.

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