Elevated cardiovascular disease risk in low-income women with a history of pregnancy loss

Abstract

ObjectivePregnancy is associated with elevated risk of cardiovascular diseases (CVD), but little is known regarding the association between CVD and specific types of pregnancy losses. The aim of this study is to investigate the effects of pregnancy loss on the risk of subsequent CVD of any type.MethodsThis prospective longitudinal study examines medical records between 1999 and 2014 for Medicaid beneficiaries born after 1982 who lived in a state that funds all reproductive health services, including induced abortion. Unique pregnancy outcomes, history of diabetes, hyperlipidaemia or CVD (International Classification of Diseases, Ninth Revision (ICD-9): 401–459) prior to their first pregnancy outcome for each woman. Cumulative incidence rates of a first CVD diagnosis following a first pregnancy were calculated for the observed period, exceeding 12 years.ResultsA history of pregnancy loss was associated with 38% (OR=1.38; 95% CI=1.37 to 1.40) higher risk of a CVD diagnosis in the period observed. After controlling for history of diabetes, hyperlipidaemia, age, year of first pregnancy, race, state of residence, months of eligibility, number of pregnancies, births, number of losses before and after the first live birth, exposure to any pregnancy loss was associated with an 18% (adjusted OR=1.18; 95% CI=1.15 to 1.21) increased risk of CVD. Our analyses also reveal an important temporal relationship between the CVD and pregnancy loss. Immediate and short-term increased CVD risk is more characteristic for women whose first pregnancy ended in live birth while a delayed and more prolonged increased risk of CVD is associated with a first pregnancy loss.ConclusionsOur findings corroborate previous research showing that pregnancy loss is an independent risk factor for CVD, especially for diseases more chronic in nature. Our research contributes to understanding the specific needs for cardiovascular health monitoring for pregnant women and developing a consistent, evidence-based screening tools for both short-term and long-term follow-up.

The risk of cardiovascular diseases after miscarriage, stillbirth, and induced abortion: a systematic review and meta-analysis

“…Recent research using a large low-income American population also adds to the weight of evidence linking abortion to cardiovascular outcomes. 48 After adjusting for multiple confounders, women whose first pregnancy ended in either miscarriage or abortion were 18% more likely to develop CVD and more likely to have a haemorrhagic stroke compared with women with only live births. Unfortunately, the American study ( n = 1 157 980) did not segregate the results associated with miscarriage and abortion separately.…”

Pregnancy complications in last pregnancy and mothers’ long-term cardiovascular mortality: does the relation differ from that of complications in first pregnancy? A population-based study

“…First, we have considered the complete reproduction of a woman in our analyses; however, we were not able to address fully the issue of pregnancy loss in relation to CVD death. Previous studies reported that pregnancy loss (miscarriage, stillbirth, and abortion) is a risk factor for CVD and early mortality [ 10 , 11 ]. However, when we analyzed our data restricted to mothers who had no lifetime perinatal loss, the results were similar to the main analysis.…”

“…Women with a history of pregnancy loss have a greater risk of CVD [ 10 ] and premature mortality up to three decades later, particularly cardiovascular, cancer, and suicide-related deaths [ 11 ]. Systematic review and meta-analyses also reported that the risk of CVD was higher among women with prior pregnancy loss (miscarriage, stillbirth, and induced abortion) [ 12 ] and pregnancy loss associated mortality is more than double that of delivery associated mortality [ 13 ].…”

Previous pregnancy loss and gestational cardiovascular health: A prospective cohort of nulliparous women

“…A history of pregnancy loss (PL), whether induced or naturally occurring, has been associated with a higher risk of subsequent metabolic disorders, including cardiovascular disease ( 15 , 16 ), premature mortality ( 17 ), type 2 diabetes ( 18 , 19 ) and atherosclerotic disease ( 20 ), especially when there is recurrent PL. Moreover, a prospective longitudinal study revealed an important temporal relationship that a delayed and more prolonged increased risk of CVD is associated with a first pregnancy loss ( 21 ). However, to the best of our knowledge, the early-term effects of PL on gestational cardiovascular health remain uncertain.…”