title: Cardiovascular disease risk in women with a history of spontaneous preterm delivery: A systematic review and meta-analysis.
abstract: BACKGROUND
  Increasing evidence suggests a relation between having had spontaneous preterm delivery and cardiovascular disease in the future. We performed a systematic review and meta-analysis to assess the relation between a history of spontaneous preterm delivery and risk of ischaemic heart disease (IHD), stroke or overall cardiovascular disease (CVD).
  
  
  METHODS
  We carried out a systematic search in Medline (from 1966 to 17 July 2014) and Embase (from 1980 to 17 July 2014). We included studies with a cohort design assessing the relation between spontaneous preterm delivery and fatal or nonfatal IHD, stroke, or overall CVD. IHD, stroke and CVD were assessed through linkage with national registries. Hazard ratios (HRs) were pooled using a random-effects model.
  
  
  RESULTS
  Of the 10 cohort studies included; sample sizes ranged from 3706 to 923,686 women and follow-up ranged from 12-35 years. Spontaneous preterm delivery was related to an increased risk of developing or dying from IHD (HR 1.38, 95% confidence interval (CI) 1.22-1.57), stroke (HR 1.71, 95% CI 1.53-1.91) and overall CVD (relative risk (HR) 2.01, 95% CI 1.52-2.65). All studies found a positive effect, although substantial between-study heterogeneity was found for IHD and CVD.
  
  
  CONCLUSIONS
  Spontaneous preterm delivery is an independent risk factor for the development of IHD, stroke and overall CVD.
authors: Division of Woman and Baby, University Medical Center Utrecht, the Netherlands Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands k.y.heida@umcutrecht.nl.
authors: Karst Y
authors: KY
authors: Heida
authors: Department of Radiology, University Medical Center Utrecht, the Netherlands.
authors: Birgitta K
authors: BK
authors: Velthuis
authors: Division of Woman and Baby, University Medical Center Utrecht, the Netherlands.
authors: Martijn A
authors: MA
authors: Oudijk
authors: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands.
authors: Johannes B
authors: JB
authors: Reitsma
authors: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands.
authors: Michiel L
authors: ML
authors: Bots
authors: Division of Woman and Baby, University Medical Center Utrecht, the Netherlands.
authors: Arie
authors: A
authors: Franx
authors: Department of Obstetrics and Gynaecology, Medical Center Haaglanden, the Netherlands.
authors: Frederique M
authors: FM
authors: van Dunné
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D016017:Odds Ratio; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology* / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology*; D013997:Time Factors; D055815:Young Adult
keywords: Premature birth; cardiovascular disease; ischaemic heart disease; meta-analysis; stroke