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Single‐Multiple and Recurrent Pregnancy‐Related Complications and Incident Cardiovascular Disease: A Nationwide Data Linkage Study in Wales, UK

Tariq Al Bahhawi Orcid Logo, Stephanie L. Harrison, Deirdre A. Lane Orcid Logo, Flemming Skjøth Orcid Logo, Iain Buchan Orcid Logo, Andrew Sharp Orcid Logo, Hoda Abbasizanjani Orcid Logo, Ashley Akbari Orcid Logo, Fatemeh Torabi Orcid Logo, Julian Halcox Orcid Logo, Dharani K. Hapangama Orcid Logo, Gregory Y. H. Lip Orcid Logo

Journal of the American Heart Association, Volume: 15, Issue: 5

Swansea University Authors: Hoda Abbasizanjani Orcid Logo, Ashley Akbari Orcid Logo, Fatemeh Torabi Orcid Logo, Julian Halcox Orcid Logo

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DOI (Published version): 10.1161/jaha.125.044953

Abstract

Background: Pregnancy‐related complications are linked to increased cardiovascular disease risk, but comprehensive evaluations of diverse complications, particularly multiple or recurrent events, are limited. Methods: A national retrospective cohort study was conducted using the Secure Anonymised In...

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Published in: Journal of the American Heart Association
ISSN: 2047-9980
Published: Ovid Technologies (Wolters Kluwer Health) 2026
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URI: https://cronfa.swan.ac.uk/Record/cronfa71647
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fullrecord <?xml version="1.0"?><rfc1807><datestamp>2026-04-14T16:28:40.6589474</datestamp><bib-version>v2</bib-version><id>71647</id><entry>2026-03-19</entry><title>Single&#x2010;Multiple and Recurrent Pregnancy&#x2010;Related Complications and Incident Cardiovascular Disease: A Nationwide Data Linkage Study in Wales, UK</title><swanseaauthors><author><sid>93dd7e747f3118a99566c68592a3ddcc</sid><ORCID>0000-0002-9575-4758</ORCID><firstname>Hoda</firstname><surname>Abbasizanjani</surname><name>Hoda Abbasizanjani</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>aa1b025ec0243f708bb5eb0a93d6fb52</sid><ORCID>0000-0003-0814-0801</ORCID><firstname>Ashley</firstname><surname>Akbari</surname><name>Ashley Akbari</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>f569591e1bfb0e405b8091f99fec45d3</sid><ORCID>0000-0002-5853-4625</ORCID><firstname>Fatemeh</firstname><surname>Torabi</surname><name>Fatemeh Torabi</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>3676f695eeda169d0f8c618adf27c04b</sid><ORCID>0000-0001-6926-2947</ORCID><firstname>Julian</firstname><surname>Halcox</surname><name>Julian Halcox</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2026-03-19</date><deptcode>MEDS</deptcode><abstract>Background: Pregnancy&#x2010;related complications are linked to increased cardiovascular disease risk, but comprehensive evaluations of diverse complications, particularly multiple or recurrent events, are limited. Methods: A national retrospective cohort study was conducted using the Secure Anonymised Information Linkage (SAIL) Databank in Wales. Exposures were hypertensive disorders of pregnancy, gestational diabetes, placental abruption, stillbirth, small for gestational age, fetal growth restriction, and preterm birth. Multiple complications were defined as &gt;1 complication in the first pregnancy, and recurrent complications as the same complication in both the first and second pregnancies. Outcomes were incident ischemic heart disease, stroke, heart failure, and atrial fibrillation. Cox regression estimated hazard ratios (HRs). Results: A total of 298&#x2009;515 women (mean age 27.2&#x2009;years; SD 6.1) were included. Multiple pregnancy&#x2010;related complications were associated with increased risk of ischemic heart disease (hazard ratio HR, 2.88 [95% CI, 2.27&#x2013;3.67]), stroke (HR, 2.03 [95% CI, 1.55&#x2013;2.65]), heart failure (HR, 3.18 [95% CI, 2.34&#x2013;4.32]), and atrial fibrillation (HR, 1.80 [95% CI, 1.20&#x2013;2.72]) compared with no complications. A dose&#x2013;response relationship was observed, with progressively higher cardiovascular disease risk for multiple compared with single complications and elevated risk for both groups relative to women without complications. Recurrent pregnancy&#x2010;related complications increased the risk of ischemic heart disease (HR, 1.93 [95% CI, 1.26&#x2013;2.95]), stroke (HR, 1.89 [95% CI, 1.25&#x2013;2.85]), heart failure (HR, 3.61 [95% CI, 2.32&#x2013;5.60]), and atrial fibrillation (HR, 2.45 [95% CI, 1.38&#x2013;4.37]) compared with no complication. Conclusions: Women experiencing pregnancy&#x2010;related complications encounter higher risks of cardiovascular disease, especially with multiple or recurrent complications. Comprehensive cardiovascular risks assessment and targeted prevention should be prioritized for this group.</abstract><type>Journal Article</type><journal>Journal of the American Heart Association</journal><volume>15</volume><journalNumber>5</journalNumber><paginationStart/><paginationEnd/><publisher>Ovid Technologies (Wolters Kluwer Health)</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>2047-9980</issnElectronic><keywords>atrial fibrillation; cardiovascular disease; pregnancy complications; recurrent pregnancy complications</keywords><publishedDay>3</publishedDay><publishedMonth>3</publishedMonth><publishedYear>2026</publishedYear><publishedDate>2026-03-03</publishedDate><doi>10.1161/jaha.125.044953</doi><url/><notes/><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm>Another institution paid the OA fee</apcterm><funders>Tariq Al Bahhawi is supported by a PhD scholarship from Jazan University for postgraduate studies. Gregory Y. H. Lip and Iain Buchan (NIHR205131) are supported by the National Institute for Health and Care Research</funders><projectreference/><lastEdited>2026-04-14T16:28:40.6589474</lastEdited><Created>2026-03-19T23:18:57.8035767</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Health Data Science</level></path><authors><author><firstname>Tariq Al</firstname><surname>Bahhawi</surname><orcid>0000-0003-3803-9691</orcid><order>1</order></author><author><firstname>Stephanie L.</firstname><surname>Harrison</surname><order>2</order></author><author><firstname>Deirdre A.</firstname><surname>Lane</surname><orcid>0000-0002-5604-9378</orcid><order>3</order></author><author><firstname>Flemming</firstname><surname>Skj&#xF8;th</surname><orcid>0000-0003-2975-647x</orcid><order>4</order></author><author><firstname>Iain</firstname><surname>Buchan</surname><orcid>0000-0003-3392-1650</orcid><order>5</order></author><author><firstname>Andrew</firstname><surname>Sharp</surname><orcid>0000-0003-3396-7464</orcid><order>6</order></author><author><firstname>Hoda</firstname><surname>Abbasizanjani</surname><orcid>0000-0002-9575-4758</orcid><order>7</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><orcid>0000-0003-0814-0801</orcid><order>8</order></author><author><firstname>Fatemeh</firstname><surname>Torabi</surname><orcid>0000-0002-5853-4625</orcid><order>9</order></author><author><firstname>Julian</firstname><surname>Halcox</surname><orcid>0000-0001-6926-2947</orcid><order>10</order></author><author><firstname>Dharani K.</firstname><surname>Hapangama</surname><orcid>0000-0003-0270-0150</orcid><order>11</order></author><author><firstname>Gregory Y. H.</firstname><surname>Lip</surname><orcid>0000-0002-7566-1626</orcid><order>12</order></author></authors><documents><document><filename>71647__36510__29fc8e5addf944eea60ffa7f0ee8641c.pdf</filename><originalFilename>71647.VoR.pdf</originalFilename><uploaded>2026-04-14T16:26:03.6313658</uploaded><type>Output</type><contentLength>612489</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>&#xA9; 2026 The Author(s). This is an open access article under the terms of the Creative Commons Attribution- NonCommercial- NoDerivs License.</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>http://creativecommons.org/licenses/by-nc-nd/4.0/</licence></document></documents><OutputDurs/></rfc1807>
spelling 2026-04-14T16:28:40.6589474 v2 71647 2026-03-19 Single‐Multiple and Recurrent Pregnancy‐Related Complications and Incident Cardiovascular Disease: A Nationwide Data Linkage Study in Wales, UK 93dd7e747f3118a99566c68592a3ddcc 0000-0002-9575-4758 Hoda Abbasizanjani Hoda Abbasizanjani true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false f569591e1bfb0e405b8091f99fec45d3 0000-0002-5853-4625 Fatemeh Torabi Fatemeh Torabi true false 3676f695eeda169d0f8c618adf27c04b 0000-0001-6926-2947 Julian Halcox Julian Halcox true false 2026-03-19 MEDS Background: Pregnancy‐related complications are linked to increased cardiovascular disease risk, but comprehensive evaluations of diverse complications, particularly multiple or recurrent events, are limited. Methods: A national retrospective cohort study was conducted using the Secure Anonymised Information Linkage (SAIL) Databank in Wales. Exposures were hypertensive disorders of pregnancy, gestational diabetes, placental abruption, stillbirth, small for gestational age, fetal growth restriction, and preterm birth. Multiple complications were defined as >1 complication in the first pregnancy, and recurrent complications as the same complication in both the first and second pregnancies. Outcomes were incident ischemic heart disease, stroke, heart failure, and atrial fibrillation. Cox regression estimated hazard ratios (HRs). Results: A total of 298 515 women (mean age 27.2 years; SD 6.1) were included. Multiple pregnancy‐related complications were associated with increased risk of ischemic heart disease (hazard ratio HR, 2.88 [95% CI, 2.27–3.67]), stroke (HR, 2.03 [95% CI, 1.55–2.65]), heart failure (HR, 3.18 [95% CI, 2.34–4.32]), and atrial fibrillation (HR, 1.80 [95% CI, 1.20–2.72]) compared with no complications. A dose–response relationship was observed, with progressively higher cardiovascular disease risk for multiple compared with single complications and elevated risk for both groups relative to women without complications. Recurrent pregnancy‐related complications increased the risk of ischemic heart disease (HR, 1.93 [95% CI, 1.26–2.95]), stroke (HR, 1.89 [95% CI, 1.25–2.85]), heart failure (HR, 3.61 [95% CI, 2.32–5.60]), and atrial fibrillation (HR, 2.45 [95% CI, 1.38–4.37]) compared with no complication. Conclusions: Women experiencing pregnancy‐related complications encounter higher risks of cardiovascular disease, especially with multiple or recurrent complications. Comprehensive cardiovascular risks assessment and targeted prevention should be prioritized for this group. Journal Article Journal of the American Heart Association 15 5 Ovid Technologies (Wolters Kluwer Health) 2047-9980 atrial fibrillation; cardiovascular disease; pregnancy complications; recurrent pregnancy complications 3 3 2026 2026-03-03 10.1161/jaha.125.044953 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee Tariq Al Bahhawi is supported by a PhD scholarship from Jazan University for postgraduate studies. Gregory Y. H. Lip and Iain Buchan (NIHR205131) are supported by the National Institute for Health and Care Research 2026-04-14T16:28:40.6589474 2026-03-19T23:18:57.8035767 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Tariq Al Bahhawi 0000-0003-3803-9691 1 Stephanie L. Harrison 2 Deirdre A. Lane 0000-0002-5604-9378 3 Flemming Skjøth 0000-0003-2975-647x 4 Iain Buchan 0000-0003-3392-1650 5 Andrew Sharp 0000-0003-3396-7464 6 Hoda Abbasizanjani 0000-0002-9575-4758 7 Ashley Akbari 0000-0003-0814-0801 8 Fatemeh Torabi 0000-0002-5853-4625 9 Julian Halcox 0000-0001-6926-2947 10 Dharani K. Hapangama 0000-0003-0270-0150 11 Gregory Y. H. Lip 0000-0002-7566-1626 12 71647__36510__29fc8e5addf944eea60ffa7f0ee8641c.pdf 71647.VoR.pdf 2026-04-14T16:26:03.6313658 Output 612489 application/pdf Version of Record true © 2026 The Author(s). This is an open access article under the terms of the Creative Commons Attribution- NonCommercial- NoDerivs License. true eng http://creativecommons.org/licenses/by-nc-nd/4.0/
title Single‐Multiple and Recurrent Pregnancy‐Related Complications and Incident Cardiovascular Disease: A Nationwide Data Linkage Study in Wales, UK
spellingShingle Single‐Multiple and Recurrent Pregnancy‐Related Complications and Incident Cardiovascular Disease: A Nationwide Data Linkage Study in Wales, UK
Hoda Abbasizanjani
Ashley Akbari
Fatemeh Torabi
Julian Halcox
title_short Single‐Multiple and Recurrent Pregnancy‐Related Complications and Incident Cardiovascular Disease: A Nationwide Data Linkage Study in Wales, UK
title_full Single‐Multiple and Recurrent Pregnancy‐Related Complications and Incident Cardiovascular Disease: A Nationwide Data Linkage Study in Wales, UK
title_fullStr Single‐Multiple and Recurrent Pregnancy‐Related Complications and Incident Cardiovascular Disease: A Nationwide Data Linkage Study in Wales, UK
title_full_unstemmed Single‐Multiple and Recurrent Pregnancy‐Related Complications and Incident Cardiovascular Disease: A Nationwide Data Linkage Study in Wales, UK
title_sort Single‐Multiple and Recurrent Pregnancy‐Related Complications and Incident Cardiovascular Disease: A Nationwide Data Linkage Study in Wales, UK
author_id_str_mv 93dd7e747f3118a99566c68592a3ddcc
aa1b025ec0243f708bb5eb0a93d6fb52
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3676f695eeda169d0f8c618adf27c04b
author_id_fullname_str_mv 93dd7e747f3118a99566c68592a3ddcc_***_Hoda Abbasizanjani
aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
f569591e1bfb0e405b8091f99fec45d3_***_Fatemeh Torabi
3676f695eeda169d0f8c618adf27c04b_***_Julian Halcox
author Hoda Abbasizanjani
Ashley Akbari
Fatemeh Torabi
Julian Halcox
author2 Tariq Al Bahhawi
Stephanie L. Harrison
Deirdre A. Lane
Flemming Skjøth
Iain Buchan
Andrew Sharp
Hoda Abbasizanjani
Ashley Akbari
Fatemeh Torabi
Julian Halcox
Dharani K. Hapangama
Gregory Y. H. Lip
format Journal article
container_title Journal of the American Heart Association
container_volume 15
container_issue 5
publishDate 2026
institution Swansea University
issn 2047-9980
doi_str_mv 10.1161/jaha.125.044953
publisher Ovid Technologies (Wolters Kluwer Health)
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
active_str 0
description Background: Pregnancy‐related complications are linked to increased cardiovascular disease risk, but comprehensive evaluations of diverse complications, particularly multiple or recurrent events, are limited. Methods: A national retrospective cohort study was conducted using the Secure Anonymised Information Linkage (SAIL) Databank in Wales. Exposures were hypertensive disorders of pregnancy, gestational diabetes, placental abruption, stillbirth, small for gestational age, fetal growth restriction, and preterm birth. Multiple complications were defined as >1 complication in the first pregnancy, and recurrent complications as the same complication in both the first and second pregnancies. Outcomes were incident ischemic heart disease, stroke, heart failure, and atrial fibrillation. Cox regression estimated hazard ratios (HRs). Results: A total of 298 515 women (mean age 27.2 years; SD 6.1) were included. Multiple pregnancy‐related complications were associated with increased risk of ischemic heart disease (hazard ratio HR, 2.88 [95% CI, 2.27–3.67]), stroke (HR, 2.03 [95% CI, 1.55–2.65]), heart failure (HR, 3.18 [95% CI, 2.34–4.32]), and atrial fibrillation (HR, 1.80 [95% CI, 1.20–2.72]) compared with no complications. A dose–response relationship was observed, with progressively higher cardiovascular disease risk for multiple compared with single complications and elevated risk for both groups relative to women without complications. Recurrent pregnancy‐related complications increased the risk of ischemic heart disease (HR, 1.93 [95% CI, 1.26–2.95]), stroke (HR, 1.89 [95% CI, 1.25–2.85]), heart failure (HR, 3.61 [95% CI, 2.32–5.60]), and atrial fibrillation (HR, 2.45 [95% CI, 1.38–4.37]) compared with no complication. Conclusions: Women experiencing pregnancy‐related complications encounter higher risks of cardiovascular disease, especially with multiple or recurrent complications. Comprehensive cardiovascular risks assessment and targeted prevention should be prioritized for this group.
published_date 2026-03-03T05:47:35Z
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