Does pregnancy complication history improve cardiovascular disease risk prediction? Findings from the HUNT study in Norway

Research output: Contribution to journalArticle


Aim: To evaluate whether history of pregnancy complications [pre-eclampsia, gestational hypertension, preterm delivery, or small for gestational age (SGA)] improves risk prediction for cardiovascular disease (CVD).

Methods and results: This population-based, prospective cohort study linked data from the HUNT Study, Medical Birth Registry of Norway, validated hospital records, and Norwegian Cause of Death Registry. Using an established CVD risk prediction model (NORRISK 2), we predicted 10-year risk of CVD (non-fatal myocardial infarction, fatal coronary heart disease, and non-fatal or fatal stroke) based on established risk factors (age, systolic blood pressure, total and HDL-cholesterol, smoking, anti-hypertensives, and family history of myocardial infarction). We evaluated whether adding pregnancy complication history improved model fit, calibration, discrimination, and reclassification. Among 18 231 women who were parous, ≥40 years of age, and CVD-free at start of follow-up, 39% had any pregnancy complication history and 5% experienced a CVD event during a median follow-up of 8.2 years. While pre-eclampsia and SGA were associated with CVD in unadjusted models (HR 1.96, 95% CI 1.44-2.65 for pre-eclampsia and HR 1.46, 95% CI 1.18-1.81 for SGA), only pre-eclampsia remained associated with CVD after adjusting for established risk factors (HR 1.60, 95% CI 1.16-2.17). Adding pregnancy complication history to the established prediction model led to small improvements in discrimination (C-index difference 0.004, 95% CI 0.002-0.006) and reclassification (net reclassification improvement 0.02, 95% CI 0.002-0.05).

Conclusion: Pre-eclampsia independently predicted CVD after controlling for established risk factors; however, adding pre-eclampsia, gestational hypertension, preterm delivery, and SGA made only small improvements to CVD prediction among this representative sample of parous Norwegian women.


  • Amanda R Markovitz
  • Jennifer J Stuart
  • Julie Horn
  • Paige L Williams
  • Eric B Rimm
  • Stacey A Missmer
  • Lauren J Tanz
  • Eirin B Haug
  • Abigail Fraser
  • Simon Timpka
  • Bjørnar Klykken
  • Håvard Dalen
  • Pål R Romundstad
  • Janet W Rich-Edwards
  • Bjørn Olav Åsvold
External organisations
  • Harvard T.H. Chan School of Public Health
  • Norwegian University of Science and Technology
  • Brigham and Women's Hospital / Harvard Medical School
  • Boston Children's Hospital
  • University of Bristol
  • St. Olav’s University Hospital
  • Nord-Trøndelag Health Trust
  • Harvard University
  • Brigham and Women's Hospital, Boston
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cardiac and Cardiovascular Systems
  • Obstetrics, Gynecology and Reproductive Medicine
Original languageEnglish
Pages (from-to)1113–1120
JournalEuropean Heart Journal
Issue number14
Early online date2018 Dec 27
Publication statusPublished - 2019
Publication categoryResearch