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.

Background Cardiovascular disease (CVD) is the leading cause of death in women, responsible for approximately a third of all female deaths. Pregnancy complications are known to be associated with a greater risk of incident CVD in mothers. However, the relationships between pregnancy loss due to miscarriage, stillbirth, or therapeutic abortion, and future maternal cardiovascular health are under-researched. This study seeks to provide an up-to-date systematic review and meta-analysis of the relationship between these three forms of pregnancy loss and the subsequent development of CVD. Methods This systematic review will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis checklist (PRISMA) and the Meta-analyses Of Observational Studies in Epidemiology (MOOSE) Checklist. A systematic search will be undertaken using publications identified in MEDLINE (PubMed), Scopus, Web of Knowledge, the CINAHL Nursing Database, and the Cochrane Library. The eligibility of each publication will be determined by predefined selection criteria. The quality of the included studies will be rated using the Newcastle-Ottawa Scale. Pooled measures of association will be computed using random-effects model meta-analyses. Between-study heterogeneity will be assessed using the I2 statistic and the Cochrane χ2 statistic. Small study effects will be evaluated for meta-analyses with sufficient studies through the use of funnel plots and Egger’s test. Discussion The results of this systematic review will discuss the long-term risks of multiple types of cardiovascular disease in women who have experienced miscarriage, stillbirth, and/or therapeutic abortion. It will contribute to the growing field of cardio-obstetrics as the first to consider the full breadth of literature regarding the association between all forms of pregnancy loss and future maternal cardiovascular disease. Systematic review registration PROSPERO registration number [CRD42020167587]

Purpose Ethical concerns about the use of the Mental Health Act (MHA) have led to calls for developmental disorders to be removed from the list of mental disorders for which individuals can be detained. In parallel, there are long-standing concerns of ethnic disparity in the application of the MHA. Nonetheless, the impact of the intersections of developmental disorder diagnosis, adolescence and ethnicity on the application of the MHA is unknown. This study aims to explore ethnic differences in MHA sections and the factors accounting for this, in an adolescent inpatient developmental disorder service. Design/methodology/approach File reviews were conducted to explore differences in MHA status, as well as demographic, clinical and risk factors that may account for this, between 39 white British and ethnic minority adolescents detained to a specialist inpatient developmental disorder service. Findings Consistent with adult literature, adolescents of an ethnic minority were overrepresented in the sample and were significantly more likely to be detained on Part III or “forensic” sections of the MHA than White British counterparts, with five times greater risk. Analyses revealed no significant differences between ethnic minority and white British participants on demographic variables, clinical needs, risk behaviours, risk measures nor application of restrictive practices and safeguarding procedures. Practical implications National audits exploring patterns of detention under the MHA across adolescent developmental disorder populations need to include analysis of intersections to ensure that the MHA is used as a means of last resort and in an equitable manner. Originality/value To the best of the authors’ knowledge, this paper is the first comprehensive exploration of the impact of ethnicity on detention patterns in ethnic minority and White British populations.

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