{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T11:45:46Z","timestamp":1782992746660,"version":"3.54.5"},"reference-count":54,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,3,17]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">In utero exposures to certain pathologies during pregnancy increase offspring cardiovascular disease (CVD) risks, and pregnancy complications and CVD risks are higher in twins than in singletons. However, the association between placental abruption and nonfatal incident CVD in twin offspring, and whether the abruption effects are mediated through preterm delivery, is unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">We used the PACER (Placental Abruption and Cardiovascular Event Risk) offspring cohort, which links births to hospitalizations and mortality records in New Jersey from 1993 to 2020 (28\u2009years of follow\u2010up) and is restricted to twin offspring. In a Cox model, we estimated the counterfactual decomposition of the abruption\u2013CVD association into a natural direct and indirect effect through preterm delivery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">Of 116\u2009796 twin births, 2597 (2.2%) were complicated by abruption. The rate of incident CVD was higher among abruption than nonabruption births (1560 versus 577 per 100\u2009000 person\u2010years). Abruption was associated with a 2.47\u2010fold increased risk of CVD in the twin offspring, with similar risks for heart disease and stroke. Results indicated that 40% of the total effect was mediated through preterm delivery &lt;37\u2009weeks; the proportion mediated increased with earlier gestational ages at delivery. These risks persisted after accounting for unmeasured confounding bias.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Placental abruption is associated with higher CVD risk in twins through early adulthood, with substantial mediation of effects through preterm delivery. Efforts to optimize obstetric care for pregnant women carrying twins to reduce the risk of abruption may be worthy of consideration. This may translate to public health benefits in reducing CVD in twin offspring.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.042202","type":"journal-article","created":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T10:32:21Z","timestamp":1773138741000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Placental Abruption, Preterm Delivery, and Cardiovascular Disease in Twin Offspring"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-0592-3000","authenticated-orcid":false,"given":"Rachel","family":"Lee","sequence":"first","affiliation":[{"name":"Rutgers Robert Wood Johnson Medical School","place":["New Brunswick"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1131-8148","authenticated-orcid":false,"given":"Emily B.","family":"Rosenfeld","sequence":"additional","affiliation":[{"name":"Rutgers Robert Wood Johnson Medical School","place":["New Brunswick"]},{"name":"Rutgers Robert Wood Johnson Medical School","place":["New Brunswick"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Valeri","sequence":"additional","affiliation":[{"name":"Columbia University","place":["New York"]},{"name":"Harvard T.H. Chan School of Public Health","place":["Boston"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0543-9798","authenticated-orcid":false,"given":"William J.","family":"Kostis","sequence":"additional","affiliation":[{"name":"Rutgers Robert Wood Johnson Medical School","place":["New Brunswick"]},{"name":"Rutgers Robert Wood Johnson Medical School","place":["New Brunswick"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0410-2595","authenticated-orcid":false,"given":"Cande V.","family":"Ananth","sequence":"additional","affiliation":[{"name":"Rutgers Robert Wood Johnson Medical School","place":["New Brunswick"]},{"name":"Rutgers Robert Wood Johnson Medical School","place":["New Brunswick"]},{"name":"Rutgers Robert Wood Johnson Medical School","place":["New Brunswick"]},{"name":"Rutgers School of Public Health","place":["Piscataway"]},{"name":"Rutgers Robert Wood Johnson Medical School","place":["Piscataway"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001209"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2017.154"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.118.037137"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000950"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.2307"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2023.05.006"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.285122"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-149-2-200807150-00005"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.03.529"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l6398"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2022-072157"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.104.490326"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2019.1327"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-015-0085-7"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.113"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.001805"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2018.12.008"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0041-1728823"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/153.8.771"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2022.06.059"},{"key":"e_1_3_2_22_2","volume-title":"Acute Placental Abruption: Pathophysiology, Clinical Features, Diagnosis, and Consequences","author":"Ananth CV","year":"2019","unstructured":"Ananth CV, Kinzler WL. 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