Nathalie Auger1,2,3,4, Sophie Marcoux5, Gilles Paradis6,7, Jessica Healy-Profitós5,6, Shu Qin Wei6,8, Brian J Potter5,9. 1. University of Montreal Hospital Research Centre, 900 Saint Denis St., Montreal, QC, H2X 0A9, Canada. nathalie.auger@inspq.qc.ca. 2. Institut national de santé publique du Québec, 190 Cremazie Blvd E, Montreal, QC, H2P 1E2, Canada. nathalie.auger@inspq.qc.ca. 3. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Ave W., Montreal, QC, H3A 1A2, Canada. nathalie.auger@inspq.qc.ca. 4. Department of Social and Preventive Medicine, School of Public Health, University of Montreal, C.P. 6l28, Succursale Centre-ville, Montreal, QC, H3C 3J7, Canada. nathalie.auger@inspq.qc.ca. 5. University of Montreal Hospital Research Centre, 900 Saint Denis St., Montreal, QC, H2X 0A9, Canada. 6. Institut national de santé publique du Québec, 190 Cremazie Blvd E, Montreal, QC, H2P 1E2, Canada. 7. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Ave W., Montreal, QC, H3A 1A2, Canada. 8. Sainte-Justine Hospital Research Centre, University of Montreal, Montreal, QC, Canada. 9. Division of Cardiology, Department of Medicine, University of Montreal Hospital Center, Montreal, QC, Canada.
Abstract
PURPOSE: The association between placental detachment disorders and risk of chronic disease is unclear. We determined the association of placenta accreta and retained placenta with risk of future maternal cardiovascular disease and cancer. METHODS: We tracked a longitudinal cohort of 541,051 pregnant women over a period of 13 years (2006-2019) in Quebec, Canada. The main exposure measures were placenta accreta and retained placenta in any pregnancy. Outcomes included future hospitalizations for cardiovascular disease and cancer. Using Cox regression models adjusted for maternal characteristics, we estimated hazard ratios (HR) and 95% confidence intervals (CI) for the association of accreta and retained placenta with cardiovascular disease and cancer at 13 years. RESULTS: The incidence of cardiovascular hospitalization was 21.2 per 10,000 person-years for accreta and 23.4 per 10,000 for retained placenta with postpartum hemorrhage, compared with 20.3 per 10,000 for neither placental disorder. Cancer incidence followed a similar pattern, with rates highest for retained placenta with hemorrhage. Retained placenta with hemorrhage was associated with 1.19 times the risk of cardiovascular disease (95% CI 1.03-1.38) and 1.27 times the risk of cancer (95% CI 1.06-1.53). Retained placenta with hemorrhage was associated with heart failure (HR 1.84, 95% CI 1.04-3.27), cardiomyopathy (HR 1.88, 95% CI 1.03-3.43), and cervical cancer (HR 2.03, 95% CI 1.17-3.52). Accreta and retained placenta without hemorrhage were not associated with these outcomes. CONCLUSION: Retained placenta with hemorrhage may be a risk marker for cardiovascular disease and certain cancers later in life.
PURPOSE: The association between placental detachment disorders and risk of chronic disease is unclear. We determined the association of placenta accreta and retained placenta with risk of future maternal cardiovascular disease and cancer. METHODS: We tracked a longitudinal cohort of 541,051 pregnant women over a period of 13 years (2006-2019) in Quebec, Canada. The main exposure measures were placenta accreta and retained placenta in any pregnancy. Outcomes included future hospitalizations for cardiovascular disease and cancer. Using Cox regression models adjusted for maternal characteristics, we estimated hazard ratios (HR) and 95% confidence intervals (CI) for the association of accreta and retained placenta with cardiovascular disease and cancer at 13 years. RESULTS: The incidence of cardiovascular hospitalization was 21.2 per 10,000 person-years for accreta and 23.4 per 10,000 for retained placenta with postpartum hemorrhage, compared with 20.3 per 10,000 for neither placental disorder. Cancer incidence followed a similar pattern, with rates highest for retained placenta with hemorrhage. Retained placenta with hemorrhage was associated with 1.19 times the risk of cardiovascular disease (95% CI 1.03-1.38) and 1.27 times the risk of cancer (95% CI 1.06-1.53). Retained placenta with hemorrhage was associated with heart failure (HR 1.84, 95% CI 1.04-3.27), cardiomyopathy (HR 1.88, 95% CI 1.03-3.43), and cervical cancer (HR 2.03, 95% CI 1.17-3.52). Accreta and retained placenta without hemorrhage were not associated with these outcomes. CONCLUSION: Retained placenta with hemorrhage may be a risk marker for cardiovascular disease and certain cancers later in life.
Authors: Outi Riihimäki; Minna Tikkanen; Johanna Melin; Sture Andersson; Marjo Metsäranta; Mika Nuutila; Mika Gissler; Jorma Paavonen; Eero Pukkala Journal: Acta Oncol Date: 2018-09-28 Impact factor: 4.089
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