title: Preterm birth and long-term maternal cardiovascular health.
abstract: OBJECTIVE
  To investigate whether preterm birth (PTB) is associated with greater cardiovascular disease (CVD) risk in a longitudinal cohort.
  
  
  METHODS
  We examined differences in systolic blood pressure (SBP), diastolic blood pressure, insulin resistance (Homeostatic model assessment of insulin resistance), total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein, triglycerides, C-reactive protein, and interleukin 6 at 3 years postpartum between women who delivered preterm (gestation <37 weeks; n = 54) versus term (≥37 weeks; n = 751) using multivariable linear regression. We also assessed relations with body mass index, weight change from prepregnancy, and waist circumference at 3 and 7 years postpartum.
  
  
  RESULTS
  Median age at enrollment was 33.9 years (range: 16.4-44.9). After adjusting for age, race, prepregnancy body mass index, parity, marital status, education, and SBP during early pregnancy, women with PTB had 3.99 mm Hg (95% confidence interval, 0.82-7.16) higher SBP and 7.01 mg/dL (1.54-12.50) lower HDL than those who delivered at term. The association with SBP was attenuated after accounting for hypertension before or during pregnancy (2.78 mm Hg [-0.30 to 5.87]). PTB was not related to other postpartum outcomes.
  
  
  CONCLUSIONS
  PTB is related to greater CVD risk by 3 years postpartum as indicated by higher SBP and lower HDL. Although these associations may be due to preexisting conditions exacerbated during pregnancy, PTB may flag high-risk women for more vigilant CVD monitoring and lifestyle interventions.
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Electronic address: wei.perng@gmail.com.
authors.forename: Wei
authors.initials: W
authors.lastname: Perng
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Stuart
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.
authors.forename: Sheryl L
authors.initials: SL
authors.lastname: Rifas-Shiman
authors.affiliation: Connors Center for Women's Health, Brigham and Women's Hospital, Boston, MA.
authors.forename: Janet W
authors.initials: JW
authors.lastname: Rich-Edwards
authors.affiliation: Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill.
authors.forename: Alison
authors.initials: A
authors.lastname: Stuebe
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA; Department of Nutrition, Harvard School of Public Health, Boston, MA.
authors.forename: Emily
authors.initials: E
authors.lastname: Oken
mesh_terms: D000293:Adolescent; D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000032:analysis; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D002784:Cholesterol / Q000097:blood; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D015850:Interleukin-6 / Q000097:blood; D008137:Longitudinal Studies; D008429:Maternal Welfare; D015999:Multivariate Analysis; D011247:Pregnancy; D047928:Premature Birth; D012044:Regression Analysis; D012307:Risk Factors; D012959:Socioeconomic Factors; D014280:Triglycerides / Q000097:blood; D055815:Young Adult
chemical_list: D015850:Interleukin-6; D014280:Triglycerides; D002097:C-Reactive Protein; D002784:Cholesterol
keywords: Cardiovascular disease risk; HDL; Hypertension; Longitudinal; Preterm birth; Reproductive-aged women; SBP