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Women with a history of pregnancy complications have an increased risk of cardiovascular disease (CVD) later in life. The overall aims were to investigate pregnancy complications as cardiovascular risk factors; whether they have predictive value for the spread of atherosclerosis in older women, whether they are associated with atherosclerotic CVD after adjusting for major confounders, both at the population-level and in women with structural heart disease; and to investigate cardiovascular biomarkers in women with spontaneous preterm birth.

Among 307 postmenopausal women with and without CVD, the self-reported frequency of pregnancy complications was assessed, and three vascular beds were examined (peripheral, carotid and coronary arteries). The self-reported complications were evaluated as possible predictors of spreading atherosclerosis. 

Exposures to pregnancy complications of a population-based cohort, including 2 134 239 women from the national Medical Birth Register from 1973 to 2014, were evaluated as a risk factor for atherosclerotic cardiovascular outcomes (hospitalizations and mortality) after adjustment for major confounders. The associations were further analyzed in 2554 women from the same cohort identified as having structural heart disease, and also for hospitalizations for heart failure and arrhythmias.

A first screening phase used comparative mass spectrometry to examine differences in protein expression in mid-pregnancy plasma samples, from the Uppsala Biobank for Pregnant Women, from a subset of women with spontaneous preterm birth in first pregnancy and controls. Seven protein biomarkers differed significantly between cases and controls. In a second validation phase, plasma samples and data on cardiovascular risk factors were collected from 65 women who agreed to participate in a follow-up visit 4–15 years after pregnancy. Concentrations of the selected biomarkers were analyzed, as well as lipid profiles from samples from both pregnancy (Biobank) and follow-up.

In conclusion, an association between pregnancy complications and the spread of atherosclerosis in older women was not found. Pregnancy complications were associated with an increased risk of atherosclerotic cardiovascular outcomes, both at the population level and in women with structural heart disease, after adjustment for major confounding factors. Compared with women without preterm birth, those with spontaneous preterm birth had higher concentrations of fibrinogen and triglycerides, both at mid-pregnancy and a decade after pregnancy.