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Objective: To examine the associations between interpregnancy interval and later maternal cardiovascular disease (CVD) risk.Design: Population-based record linkage study.Setting: New South Wales, Australia, 1994-2011.Population: 216 467 women having first and second liveborn singleton infants, excluding those with an existing or pregnancy-related CVD risk factor.Methods: We linked birth records of mothers to the mothers' subsequent CVD (coronary heart disease, cerebrovascular events, and chronic heart failure) hospitalisation or death. Multivariable Cox proportional hazard regression was used to estimate adjusted hazard ratios (AHR) [95% confidence interval (CI)], accounting for maternal age, parity, socioeconomic status, and smoking during pregnancy.Main Outcome Measures: The first occurrence of a CVD hospitalisation or death after the second birth.Results: In comparison with mothers with an interpregnancy interval of 18-23 months (reference category), the AHR among mothers with interpregnancy interval of <12 months was 1.56 (95% CI 1.18-2.07) and of 12-17 months was 1.13 (95% CI 0.84-1.51). The AHRs were 1.40 (95% CI 1.07-1.82), 1.87 (95% CI 1.21-2.89), and 3.41 (95% CI 1.07-10.91), corresponding to interpregnancy intervals of 24-59, 60-119, and ≥120 months, respectively. AHRs of specific CVD categories showed a similar pattern.Conclusions: Interpregnancy interval is associated with the risk of subsequent maternal CVD in a J-shaped fashion. The association is independent of the existing and pregnancy-related CVD risk factors analysed. Both short and long interpregnancy intervals can be used as risk markers to identify women with an elevated CVD risk later in life.Tweetable Abstract: Interpregnancy interval is associated with the risk of subsequent maternal cardiovascular disease in a J-shaped fashion. [ABSTRACT FROM AUTHOR]

Background: Historically, pregnancies among women with prosthetic heart valves have been associated with an increased incidence of adverse outcomes., Objectives: Systematic review to assess risk of adverse pregnancy outcomes among women with a prosthetic heart valve(s) over the last 20 years., Search Strategy: Electronic literature search of Medline, The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature and Embase to find recent studies., Selection Criteria: Studies of pregnant women with heart valve prostheses including trials, cohort studies and unselected case series., Data Collection and Analysis: Primary analysis calculated absolute risks and 95% confidence intervals (CI) for pregnancy outcomes using a random effects model. The Freeman-Tukey transformation was utilised in secondary analysis due to the large number of individual study outcomes with zero events., Main Results: Eleven studies capturing 499 pregnancies among women with heart valve prostheses, including 256 mechanical and 59 bioprosthetic, were eligible for inclusion. Pooled estimate of maternal mortality was 1.2/100 pregnancies (95% CI 0.5-2.2), for mechanical valves subgroup 1.8/100 (95% CI 0.5-3.7) and bioprosthetic subgroup 0.7/100 (95% CI 0.1-4.5), overall pregnancy loss 20.8/100 pregnancies (95% CI 9.5-35.1), perinatal mortality 5.0/100 births (95%CI 1.8-9.8) and thromboembolism 9.3/100 pregnancies (95% CI 4.0-16.5)., Conclusions: Women with heart valve prostheses experienced higher rates of adverse outcomes than expected in a general obstetric population; however, lower than previously reported. Women with bioprostheses had significantly fewer thromboembolic events compared to women with mechanical valves. Women should be counselled pre-pregnancy about risk of maternal death and pregnancy loss. Vigilant surveillance by a multidisciplinary team throughout the perinatal period remains warranted for these women and their infants., Tweetable Abstract: Metaanalysis suggests improvement in #pregnancy outcomes among women with #heartvalveprostheses., (© 2015 Royal College of Obstetricians and Gynaecologists.)