Aims Women who deliver pre-term have higher future risks of hypertension and ischaemic heart disease, but long-term risks of heart failure (HF) are unknown. We examined these risks in a large national cohort. Methods and results All 2 201 284 women with a singleton delivery in Sweden during 1973–2015 were followed up for inpatient or outpatient HF diagnoses through 2015. Cox regression was used to compute hazard ratios (HRs) for HF associated with pregnancy duration, adjusting for other maternal factors. Co-sibling analyses assessed for confounding by shared familial (genetic and/or environmental) factors. In 48.2 million person-years of follow-up, 19 922 women were diagnosed with HF (median age: 60.7 years). Within 10 years after delivery, the adjusted HR was 2.96 [95% confidence interval (CI): 2.48–3.53] for HF associated with pre-term (gestational age: <37 weeks) compared with full-term (39–41 weeks) delivery. Stratified HRs were 4.27 (2.54–7.17) for extremely pre-term (22–27 weeks), 3.39 (2.57–4.48) for moderately pre-term (28–33 weeks), 2.70 (2.19–3.32) for late pre-term (34–36 weeks), and 1.70 (1.45–1.98) for early term (37–38 weeks). These HRs declined but remained elevated at 10–19 years (pre-term vs. full term: HR: 2.19; 95% CI: 1.94–2.46), 20–29 years (1.80; 1.67–1.95), and 30–43 years (1.56; 1.47–1.66) after delivery, and were not explained by shared familial factors. Conclusion Pre-term and early term delivery were associated with markedly increased future hazards for HF, which persisted after adjusting for other maternal and familial factors and remained elevated 40 years later. Pre-term and early-term delivery should be recognized as risk factors for HF across the life course. Key Question What are the long-term hazards for heart failure (HF) across the life course in women who deliver preterm? Key Finding Preterm and early term delivery were associated with ∼3- and 1.7-fold adjusted hazards for HF in the next 10 years vs. full-term delivery. These hazards declined but remained elevated 40 years later, and were not explained by shared familial factors. Take Home Message Preterm and early term delivery were associated with increased future hazards for HF, which persisted for 40 years after adjusting for other maternal and familial factors. Preterm and early term delivery should be recognized as lifelong risk factors for HF.

中文翻译：

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女性早产和心力衰竭的长期风险：一项全国队列和兄弟姐妹研究


目标 早产女性未来患高血压和缺血性心脏病的风险较高，但心力衰竭 (HF) 的长期风险尚不清楚。我们在全国范围内的大型队列中研究了这些风险。方法和结果 1973 年至 2015 年期间，瑞典所有 2 201 284 名单胎分娩妇女均在 2015 年期间对住院或门诊 HF 诊断进行了随访。Cox 回归用于计算与妊娠持续时间相关的 HF 风险比 (HR)，并调整其他母体因素。共同兄弟姐妹分析评估了共同的家族（遗传和/或环境）因素的混杂因素。在 4820 万人年的随访中，19922 名女性被诊断患有心力衰竭（中位年龄：60.7 岁）。产后 10 年内，与足月（39-41 周）相比，早产（胎龄：<37 周）相关心力衰竭的调整后 HR 为 2.96 [95% 置信区间 (CI)：2.48-3.53]送货。极度早产（22-27周）的分层HR为4.27（2.54-7.17），中度早产（28-33周）为3.39（2.57-4.48），晚期早产为2.70（2.19-3.32） （34-36 周），早期（37-38 周）为 1.70 (1.45-1.98)。这些 HR 在 10-19 岁时有所下降，但仍保持较高水平（早产儿与足月儿：HR：2.19；95% CI：1.94-2.46）、20-29 岁（1.80；1.67-1.95）和 30-43 岁(1.56; 1.47–1.66) 是在分娩后发生的，并且不能用共同的家庭因素来解释。结论 早产和早期足月分娩与未来心力衰竭风险显着增加相关，在调整其他孕产妇和家庭因素后，这种风险仍然存在，并且在 40 年后仍保持较高水平。应将早产和早产视为整个生命过程中心力衰竭的危险因素。 关键问题 对于早产妇女，其整个生命过程中心力衰竭 (HF) 的长期危害有哪些？主要发现 与足月分娩相比，早产和早期足月分娩与未来 10 年心衰风险的调整后风险分别高出 3 倍和 1.7 倍。 40 年后，这些危险有所下降，但仍然很高，并且不能用共同的家庭因素来解释。小贴士 早产和早期足月分娩与未来心力衰竭风险的增加有关，在调整其他孕产妇和家庭因素后，这种风险持续了 40 年。应将早产和早期足月分娩视为心力衰竭的终生危险因素。