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Liv Grimstvedt Kvalvik at the University of Bergen recommends looking at a woman's pregnancy history to see if there is reason to implement preventive measures already before she shows any signs of cardiovascular diseases.

Complicated pregnancies increase the risk of dying of cardiovascular disease

40-year-olds who have had complicated pregnancies are three to five times more likely to die from atherosclerotic cardiovascular diseases before they turn 69.

Previous research has shown that women with complications during pregnancy have about twice the risk of dying from cardiovascular disease later.

However, most of these studies have focused on individual complications and not full pregnancy histories.

“Pregnancy history is a unique feature of women's health, readily available at no cost, and relevant to the most frequent cause of death facing women,” Liv Grimstvedt Kvalvik says. She is an associate professor at the University of Bergen's Department of Global Public Health and Primary Care.

She has examined the link between a women's pregnancy history at the age of 40 and the risk of dying from atherosclerotic cardiovascular disease (ASCVD). Kvalvik has worked with researchers from the  National Institute of Environmental Health Sciences in the USA and colleagues at the University of Bergen.

Three to five times higher risk

The study combined several Norwegian registries covering the period 1967 to 2020. More than 800,000 women surviving to 40 years of age were identified.

The data shows the number of recorded pregnancies among the women, from zero to four. The number of complications is also included. Complications include preterm delivery before 35 gestational weeks, preeclampsia (high blood pressure and protein in the urine), placental abruption (when the placenta separates from the uterus), perinatal death, and birth weight of less than 2,700 grams at term or near term. 

What Kvalvik looked for were correlations between these factors and women's risk of dying from ASCVD before they were 69 years old. 

The researchers found that pregnancy history at 40 years of age is strongly associated with ASCVD mortality:

According to Kvalvik, women who had more than one complicated pregnancy by the age of 40 had three to five times or even higher risk of ASCVD compared with women who have three pregnancies without complications. 

Within each level of total number of pregnancies women had by age 40, mortality risk increased with increasing number of complicated pregnancies.

May benefit from interventions at an early age

“There's increasing scientific evidence supporting the associations between adverse pregnancy outcomes and later cardiovascular disease, even as women with complications may be unaware of their increased risk,” says Kvalvik.

She suggests that the research indicates the importance of reviewing a woman's complete pregnancy history to determine if she could benefit from interventions to prevent disease before other clinical signs of cardiovascular disease have developed. 


Kvalvik et al. Pregnant History at 40 Years of Age as a Marker of Cardiovascular RiskJournal of the American Heart Association, vol. 13, 2024. DOI: 10.1161/JAHA.123.030560

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