Do pregnancy characteristics help to predict the future risk of maternal cardiovascular outcomes? A population-based longitudinal cohort study.

The Heart and Stroke Foundation's 2010 Report warned of "a perfect storm of heart disease looming on our horizon." It explained that unhealthy behaviours, obesity, high blood pressure, and diabetes are becoming so much more common in young Canadian women that heart disease will explode in the next generation. Health care providers use "risk assessment tools" to predict their patients' chances of having a heart attack or stroke - patients whose chances are high can then be offered help to improve their lifestyle or given medications, for example to control their blood pressure. Common risk assessment tools, however, need measurements such as cholesterol levels that are recommended only for older women and do not include pregnancy characteristics although previous studies have suggested they could be useful. Our aim in this study is to develop risk assessment tools that can be used in young women for cardiovascular disease (heart disease and stroke), and for two conditions that often precede its development, diabetes and hypertension (high blood pressure). The tools will be based on pregnancy information and other risk factors like body weight and smoking. We propose to use two databases in Nova Scotia for this study. The first is the Atlee Perinatal Database that contains detailed information on over 90,000 mothers and their pregnancies since 1988. The second is health care records that will be used to identify occurrences of cardiovascular disease, diabetes, and hypertension in these women. The mathematical equations, which combine lifestyle and pregnancy information, that best forecast a woman's chances of developing these conditions will be determined. Our approach to achieving our aim could not be done elsewhere as time efficiently and with as high quality data. Our team includes researchers and health care providers with expertise in epidemiology, statistics, and obstetrics to ensure that our results are valid and useful for health care.