Pre-Pregnancy Obesity and Associations with Stroke and Myocardial Infarction in Women in the Years after Childbirth: A Nationwide Cohort Study

Background— Cardiovascular events (stroke or myocardial infarction) are often associated with poorer prognosis in younger, compared with older individuals. We examined the associations between pre-pregnancy obesity and the risks of myocardial infarction and stroke in young, healthy women. Methods and Results— All Danish women giving birth during 2004-2009 without a history of renal disease or cardiovascular disease were identified from national registers and followed for a median time of 4.5 years (interquartile range=2.9-5.8). They were grouped according to pre-pregnancy body mass index (BMI) in underweight (BMI<18.5 kg/m 2 ), normal weight (BMI=18.5–<25 kg/m 2 ), overweight (BMI=25–<30 kg/m 2 ), and obese (BMI≥30 kg/m 2 ). The hazard ratios of myocardial infarction, stroke, and a composite outcome (myocardial infarction, ischemic stroke, cardiovascular death) were assessed using multivariable Cox regression models. We included 273,101 women with a median age of 30.4 years (interquartile range=27.2-33.8). A total of 68 women experienced a myocardial infarction, and 175 women experienced an ischemic stroke. The adjusted hazard ratios of myocardial infarction compared to normal weight were 2.50 (95% confidence interval [95% CI]=0.97-6.50) in underweight, 1.68 (95% CI=0.92-3.06) in overweight, and 2.63 (95% CI=1.41-4.91) in obese women. For ischemic stroke the adjusted hazard ratios were 1.06 (95% CI=0.44-2.28) in underweight, 1.27 (95% CI=0.87-1.85) in overweight, and 1.89 (95% CI=1.25-2.84) in obese women, respectively. For the composite outcome, hazard ratios were 1.34 (95% CI=0.81-2.20), 1.43 (95% CI=1.11-1.84) and 1.76 (95% CI=1.31-2.34) for underweight, overweight, and obese women. Conclusions— In apparently healthy women of fertile age, pre-pregnancy obesity was associated with increased risks of ischemic stroke and myocardial infarction in the years after childbirth.

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