OC 23.4 - Long-term maternal risk of cardiovascular diseases after pregnancy in the era of increasing aspirin use for preventing preeclampsia: A nationwide population-based study in the Netherlands

Background: It is unknown whether the increasing use of aspirin for preeclampsia prevention during pregnancy in the recent decade has at the same time benefited long-term maternal cardiovascular health.

Aims: To describe time trends in antiplatelet drug use during pregnancy and long-term maternal cardiovascular disease (CVD) risk.

Methods: All pregnant women who delivered between 2013 and 2020 were identified from the Dutch perinatal registry. For women with multiple pregnancies one random record was included. These data were individually linked to Statistics Netherlands where data from in-hospital diagnoses (2013-2021) and outpatient medication prescriptions (2013-2022) are available. After stratifying by calendar years of delivery, we compared antiplatelet drug use during pregnancy, and occurrence of CVD, including antihypertensive drug use, after delivery. Multivariable Cox regression (or logistic regression for the outcome antihypertensive drug use) was used to compare CVD risks between years while adjusting for demographic characteristics, prevalent cardiovascular diseases, and pregnancy complications.

Results: A total of 907,892 pregnant women were identified (age 31.4±4.8 years, gestational age 39.4±2.0 weeks). The proportion of women receiving antiplatelet drugs increased from 0.8% in 2013 to 4.8% in 2020, while anticoagulant use remained similar (≈0.8%). The 1-, 2-, 3-, and 4-year risk of heart failure and myocardial infarction after delivery was low and constant over the years (Figure 1), but the risk of ischemic stroke/TIA/arterial thromboembolism decreased (Figure 1). Results were similar when evaluated by adjusted hazard ratios (Figure 2). The proportion of women receiving ≥1 antihypertensive drug within 1 year after delivery slightly decreased from 2.68% in 2013 to 2.45% in 2020 (adjusted odds ratio 0.92, 95%CI 0.87-0.98), where the decrease was mainly observed after 2018.

Conclusion(s): With increasing antiplatelet drug use during pregnancy, a lower long-term maternal risk of arterial thromboembolism and hypertension was observed. Further studies are needed to confirm the findings and to explore possible causal relations.