Postpartum haemorrhage and risk of cardiovascular disease in later life: A Scottish population-based record linkage cohort study

Objective: To investigate the association between postpartum haemorrhage (PPH) and subsequent cardiovascular disease. Design: Population-based retrospective cohort study, using record linkage between Aberdeen Maternity and Neonatal Databank (AMND) and Scottish healthcare datasets Setting: Grampian region, Scotland Population or Sample 70,904 women who gave birth after 24 weeks of gestation, 1986-2016 Methods: We used extended Cox regression models to investigate the association between PPH in any first or later births and subsequent cardiovascular disease, adjusted for sociodemographic, medical, and pregnancy and birth-related factors. Main outcome measures Cardiovascular disease identified from prescription of selected cardiovascular medications, hospital discharge records or death from cardiovascular disease. Results: Compared with not having a PPH, having at least one PPH was associated with an increased risk of developing cardiovascular disease in the first year after birth [adjusted hazard ratio (aHR) 1.96, 95% confidence interval (CI) 1.51-2.53, p<0.001]. The association was attenuated over time, but strong evidence of increased risk remained 2-5 years (aHR 1.19, 95% CI 1.11-1.30, p<0.001) and 6-15 years after giving birth (aHR 1.17, 95% CI 1.05-1.30, p=0.005), with the direction of association reversed beyond 15 years (aHR 0.64, 95% CI 0.55-0.75, p<0.001). Conclusions: Compared with women who have never had a PPH, women who have had at least one episode of PPH are twice as likely to develop cardiovascular disease in the first year after birth and some increased risk persists for up to 15 years. Keywords: Postpartum haemorrhage, cardiovascular disease, health outcomes, Scottish data