SAN FRANCISCO — The risk for incident COPD was significantly elevated among women with a history of an adverse pregnancy outcome, according to research presented at the American Thoracic Society International Conference.

"Clinicians, especially those involved in women's primary care or obstetric medicine, should be aware of the potential association between adverse pregnancy outcomes (APOs) and COPD," Shilpa Sridhar, MD, pulmonary/critical care fellow at The Ohio State University, told Healio.

Study Design

Using the Women's Health Initiative cohort, Sridhar, Jing (Gennie) Wang, MD, assistant professor of internal medicine and medical director of the pulmonary function testing lab at The Ohio State University Wexner Medical Center, and colleagues assessed 25,541 women aged 50 to 79 years from 1993 to 1998 with at least one pregnancy lasting at least 6 months to uncover if APOs are linked to future incident COPD.

"This is not something that has been examined previously, so we were initially unsure of what to expect," Sridhar said.

The studied APOs included:

• Preterm delivery by at least 3 weeks

• Small (< 5 lb) or large (> 9 lb) for gestational age

• Gestational diabetes

• Hypertensive disorders of pregnancy

Results

Within the population, 7,226 women (28.3%) reported an APO. The study reported that the APO experienced by the greatest proportion of these women was:

• Preterm delivery (50%)

• Small gestational age infant (around 40%)

• Hypertensive disorders of pregnancy (around 20%)

• Large gestational age infant (around 19%)

• Gestational diabetes (less than 10%)

Over approximately 25 years, incident COPD was reported by 16.5% of women, and researchers found a higher proportion of women reporting incident COPD in the group with vs. without an APO (18.5% vs. 15.7%).

Following adjustment for several confounding variables (age at enrollment, race, ethnicity, smoking history, secondhand smoke exposure, asthma history, education, income, geographic region, parity, maternal low birthweight and prematurity), researchers observed a significantly elevated risk for incident COPD among women with a history of any APO (adjusted HR = 1.15; 95% CI, 1.07-1.22) compared with women without APOs.

"There have been multiple studies that have shown the association between APOs and the development of cardiovascular diseases, and it is known that COPD and cardiovascular diseases occur in similar populations," Sridhar told Healio. "Therefore, it was not unexpected that APOs were associated with the development of COPD, but it is a novel finding that deserves closer attention in future studies."

Specific APO Associations

The study further highlighted a significant link between incident COPD and three of the evaluated APOs:

• Hypertensive disorders of pregnancy: aHR = 1.27; 95% CI, 1.13-1.42

• Small gestational age infant: aHR = 1.11; 95% CI, 1.02-1.21

• Preterm delivery: aHR = 1.11; 95% CI, 1.02-1.21

Having two different APOs also significantly raised the risk for incident COPD (aHR = 1.12; 95% CI, 1.02-1.23), according to researchers.

Clinical Implications

"Gestational complications have not traditionally been recognized as risk factors for diseases such as COPD," Sridhar told Healio. "However, this study demonstrated that women who have experienced APOs are at an increased risk of developing COPD.

"While our findings need to be confirmed in other studies, we have shown for the first time that a woman's reproductive health may influence their lung health as well," she said.

Based on these study results, Sridhar told Healio there are a few ways that everyday clinicians can improve the care they provide to women with a history of APOs.

"Women with a history of APOs should be strongly encouraged to reduce other modifiable risk factors for COPD, such as smoking and exposure to environmental smoke," she said.

"Screening should be considered in patients with a history of APOs, and early pulmonary function testing or referral to a pulmonologist should be considered if symptoms such as a chronic cough or worsening shortness of breath arise," Sridhar continued.

Future Research

Moving forward, Sridhar said this association should be investigated further.

"Future studies should focus on the mechanisms underlying this association, which remain poorly understood," Sridhar told Healio. "Additional studies should also examine the relationships between gestational health and future maternal respiratory health."

Sources/Disclosures

Source:
Sridhar S, et al. Adverse pregnancy outcomes and future maternal risk of developing COPD: An analysis of the Women's Health Initiative. Presented at: American Thoracic Society International Conference; May 16-21, 2025; San Francisco.

Disclosures:
Sridhar reports no relevant financial disclosures. Wang reports receiving a CHEST research grant in women's respiratory disease.

Topics: COPD, pregnancy, preterm birth, future COPD