Adverse pregnancy outcomes put women at risk of AF

Women with a history of preterm delivery, hypertensive disorders of pregnancy, and several other pregnancy complications face an increased long-term risk of atrial fibrillation (AF), as suggested in a study.

In a large cohort of women with a singleton delivery in Sweden, the risk of AF within 10 years following delivery was elevated among women who had a history of other hypertensive disorders (hazard ratio [HR], 1.69, 95 percent confidence interval [CI], 1.32–2.15), preterm delivery (HR, 1.46, 95 percent CI, 1.26–1.70), or large for gestational age (HR, 1.16, 95 percent CI, 1.01–1.32). The risk persisted for up to 46 years. [JAMA Cardiol 2025;doi:10.1001/jamacardio.2025.3951]

Notably, the risk increase for AF did not emerge until 20 or more years after delivery for women with a history of pre-eclampsia (20–29 years: HR, 1.41, 95 percent CI, 1.33–1.50; 30–46 years: HR, 1.38, 95 percent CI, 1.33–1.42) or gestational diabetes (20–29 years: HR, 1.38, 95 percent CI, 1.13–1.68; 30–46 years: HR, 1.19, 95 percent CI, 1.03–1.37).

Women with a history of multiple adverse pregnancy outcomes had further increases in AF risk.

“Co-sibling analyses suggested that these findings were largely unexplained by genetic or environmental factors that may be shared determinants of adverse pregnancy outcomes and AF within families,” the authors noted. “However, they appeared to be substantially mediated by post-pregnancy development of other cardiovascular disorders, especially chronic hypertension.”

Describing the clinical implications of the findings, the authors stressed that pre-eclampsia, other hypertensive disorders of pregnancy, large for gestational age, gestational diabetes, and preterm delivery should be recognized as long-term risk factors for AF.

The medical care women receive before and during pregnancy needs to be of the highest standard and prioritized to reduce the prevalence of adverse pregnancy outcomes and their long-term sequelae, they added.

On the other hand, the occurrence of adverse pregnancy outcomes provides a key opportunity to identify at-risk women long before the development of AF or other cardiovascular disease, thus allowing for earlier preventive measures, such as the aggressive reduction of other known risk factors for AF, including hypertension, diabetes, obesity, sleep apnoea, heavy alcohol use, and smoking, according to the authors. [Int J Gynaecol Obstet 2019;147:1-31; J Gen Intern Med 2022;37:912-921; Lancet Reg Health Eur 2024;37:100784]

The study included 2,201,047 women with 54 million person-years of follow-up. Of these, 865,912 (39.3 percent) had a history of at least one of the six adverse pregnancy outcomes examined, the most common of which were large for gestational age (14.8 percent), small for gestational age (14.3 percent), and preterm delivery (8.9 percent). AF occurred in 51,173 women (2.3 percent), with a median age at diagnosis of 63 years.

The authors acknowledged several study limitations including the unavailability of detailed clinical records to validate AF diagnoses, as well as other parameters such as AF subtypes (eg, paroxysmal or persistent), echocardiographic data, and menopausal status during the follow-up period.