Miscarriage and future maternal cardiovascular disease: a systematic review and meta-analysis

Abstract

ContextThe 2011 American Heart Association guidelines identified pregnancy complications as a risk factor for cardiovascular disease in women. However, miscarriage was not mentioned within the guidelines, and there is no consensus on the association between miscarriage and future risk of cardiovascular disease.ObjectiveTo confirm or refute the association, a meta-analysis of published papers was conducted.Data sourcesPubMed, Web of Knowledge and Scopus were systematically searched to identify appropriate articles. Reference lists were then hand searched for additional relevant titles.Study SelectionTo be included, articles had to assess the association between miscarriage and subsequent cardiovascular disease in otherwise healthy women. Only women who had miscarriages were considered exposed. Pooled association measures, using random effects meta-analysis, were calculated for coronary heart disease and cerebrovascular disease. Publication bias and between-study heterogeneity were evaluated.Data ExtractionTwo authors individually reviewed all studies and extracted data on patient and study characteristics along with cardiovascular outcomes.Results10 studies were identified, with 517 504 individuals included in the coronary heart disease meta-analysis and 134 461 individuals in the cerebrovascular disease analysis. A history of miscarriage was associated with a greater odds of developing coronary heart disease, OR (95% CI) =1.45 (1.18 to 1.78), but not with cerebrovascular disease, OR=1.11 (0.72 to 1.69). There was a strong association between recurrent miscarriage and coronary heart disease OR=1.99 (1.13 to 3.50). Evidence was found for moderate between-study heterogeneity and publication bias in the coronary heart disease analysis.ConclusionsThe meta-analysis indicates that a history of miscarriage or recurrent miscarriage is associated with a greater risk of subsequent coronary heart disease.

Delivery of a Small-For-Gestational-Age Infant and Risk of Maternal Cardiovascular Disease – A Population-Based Record Linkage Study

“…These findings support the plausibility of direct biological mechanisms being involved, and are well-aligned with previous studies demonstrating that the magnitude of the risk of maternal CVD increases with the number and/or recurrence of other pregnancy complications, including hypertensive pregnancies [26], preterm birth [27], and miscarriage [3]. The most compelling study is a meta-analysis that showed the association of recurrent miscarriage with future maternal CVD was stronger than the association of single miscarriage (pooled odds ratios = 1.99 versus 1.45) [3].…”

“…A range of socioeconomic, behavioural, and biological risk factors shape the distribution and development of CVD. In addition to established risk factors shared by both men and women (e.g., smoking, hypercholesterolaemia, hypertension), complications during pregnancy (including preeclampsia [2], miscarriage [3], preterm birth [4] and low birth weight or fetal growth restriction [5]) have been identified as gender-specific risk factors that may help identify women who are susceptible to premature CVD. This evidence is emerging in parallel with the increased appreciation of the burden of CVD in women [6], including in women aged 18-44 years, in whom CVD is the third leading cause of death [7].…”

Increased cardiovascular disease risk in women with a history of recurrent miscarriage

“…Observational studies suggest that women with a history of RM also have an increased risk of CVD 6, 7, 8, 9. Several hypotheses are possible for the association between both diseases; shared common risk factors such as obesity and smoking,10 endothelial dysfunction,11 and a genetic predisposition is assumed 12…”

Pregnancy Loss and Carotid Intima–Media Thickness in Mexican Women

“…The relation between pregnancy loss and incident CVD has been evaluated using several study designs 35. Even though the prevalence of posttraumatic stress disorder after miscarriage and stillbirth is similar,6, 7 several studies suggest that CVD may have a stronger association with stillbirth than with miscarriage.…”