Premature Cardiac Disease and Death After Preterm Preeclampsia in Women Whose Infant Was Small for Gestational Age

To the Editor I read with great interest the population-based cohort study by Silverberg et al,¹ who found that the incidence rate of the composite outcome of heart failure, dysrhythmia, or death was 11.3 per 10 000 person-years among mothers who delivered infants with preterm birth (PTB) or who were severely small for gestational age (SGA) (crude hazard ratio, 2.79; 95% CI, 1.85-4.21) compared with women who delivered infants with term birth without severe SGA. More importantly, the hazard ratio was significantly higher in women with a PTB-SGA infant for the composite cardiac outcome of heart failure, an atrial or ventricular dysrhythmia, or coronary artery disease and was markedly attenuated when adjusted for maternal age, income quintile, preeclampsia/eclampsia, diabetes, chronic hypertension, obesity, dyslipidemia, drug dependence or smoking, and kidney disease before and after delivery. From this finding, the authors conclude that the association between preeclampsia and postpregnancy cardiovascular risk was partly due to prepregnancy risk factors. However, it seems important to underscore that the preeclampsia/eclampsia rate was higher both in the subgroup of women with an infant with PTB and severe SGA (676 of 2816 women [24.0%]) and in the subgroup with an infant with PTB without severe SGA (4077 of 45 134 [9.0%]) vs the preeclampsia/eclampsia rate in the subgroup with an infant with term birth without severe SGA (6898 of 619 311 [1.1%]).¹