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

To the Editor Silverberg et al¹ report in a large data set from Canada an increase in the incidence rate of the composite outcome of heart failure, dysrhythmia, or death among mothers delivering a preterm birth (PTB) and small for gestational age (SGA) infant. While women with known cardiac disease were excluded to the extent possible, it is plausible that women who experienced these later cardiac events were women with persistent postpartum hypertension, a variant of preeclampsia, that then resulted in chronic hypertension or had a diagnosis of peripartum cardiomyopathy that became symptomatic outside the initial 30-day period used in this study. Peripartum cardiomyopathy can be diagnosed in women without prior cardiac disease up to 5 months post partum.² As noted in the Figure,¹ the rate of rise of the event rate per 1000 person-years in the PTB-SGA group was quite high in the first year, suggesting that the events may have been pregnancy related and, if left untreated, could result in poor clinical outcomes long-term.