Aims
Miscarriage and stillbirth has been included in cardiovascular disease (CVD) risk guidelines, however heterogeneity in exposures and outcomes and the absence of reviews assessing induced abortion, prevented comprehensive assessment. We aimed to perform a systematic review and meta-analysis of the risk of cardiovascular diseases for women with prior pregnancy loss (miscarriage, stillbirth and induced abortion).
Methods and Results
Observational studies reporting risk of CVD, coronary heart disease (CHD) and stroke in women with pregnancy loss were selected after searching MEDLINE, Scopus, CINAHL, Web of Knowledge and Cochrane Library (to January 2020). Data were extracted, and study quality assessed using the Newcastle-Ottawa Scale. Pooled relative risk (RR) and 95% confidence intervals (CI) were calculated using inverse variance weighted random-effects meta-analysis.
Twenty-two studies involving 4,337,683 women were identified. Seven studies were good quality, seven were fair and eight were poor. Recurrent miscarriage was associated with a higher CHD risk (RR = 1.37, 95%CI:1.12-1.66). One or more stillbirths was associated with a higher CVD (RR = 1.41, 95%CI:1.09-1.82), CHD (RR = 1.51, 95%CI:1.04-1.29) and stroke risk (RR = 1.33, 95%CI:1.03-1.71). Recurrent stillbirth was associated with a higher CHD risk (RR = 1.28, 95%CI:1.18-1.39).). One or more abortions was associated with a higher CVD (RR = 1.04, 95%CI:1.02-1.07), as was recurrent abortion (RR = 1.09, 95%CI:1.05-1.13).
Conclusion
Women with previous pregnancy loss are at a higher CVD, CHD and stroke risk. Early identification and risk factor management is recommended. Further research is needed to understand CVD risk after abortion.
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