Recurrent Pregnancy Loss and Cardiovascular Disease Mortality in Japanese Women: A Population-Based, Prospective Cohort Study

Abstract

Recurrentpregnancy loss tends to be associated with a lower risk of mortality from cardiovascular disease at 40-79 years. Younger women have an excess risk of ischemic stroke mortality associated with recurrent pregnancy loss.

Association of spontaneous abortion with all cause and cause specific premature mortality: prospective cohort study

“…lower risk of death from cardiovascular disease. 15 In a Chinese cohort of 267 400 female textile workers, ranging in age at enrolment from 30 to over 60, self-reported spontaneous abortion was not related to death from cardiovascular disease. 16 The major methodological weakness of these previous studies is that they determined the occurrence of spontaneous abortions by retrospective recall at one time point in the long distant past or by hospital register databases, which could result in misclassification because most spontaneous abortions do not result in hospital admission.…”

“…14 In the Japanese cohort, Yamada and colleagues reported a twofold higher risk of death from ischemic stroke in a young subgroup of participants (aged 40-59) who experienced two or more pregnancy losses than those with no history of pregnancy loss. 15 Recurrent spontaneous abortion is a major stressful event in a woman's life and has been associated with adverse mental health problems, such as depression and anxiety after the loss, 42 which are increasingly known as potential risk factors for all cause mortality and mortality related to cardiovascular disease. 43 The association between spontaneous abortion and all cause premature mortality was also stronger in women who experienced their first spontaneous abortion early in their reproductive life, suggesting that spontaneous abortion at an older age is more likely an indication of age related changes, such as chromosomal abnormalities and decreased ovarian function, 44 45 rather than an early sign of underlying physiopathology resulting in a greater risk of premature death.…”

“…7 12 13 Evidence relating spontaneous abortion to mortality, however, is scant and inconsistent. [14][15][16] Major weaknesses of previous studies included retrospective assessment of spontaneous abortion in the long distant past, and lack of detailed data on various doi: 10.1136/bmj.n530 | BMJ 2021;372:n530 | the bmj relevant confounders (eg, pre-pregnancy body mass index, history of other pregnancy complications) and mediating lifestyle factors (body mass index, quality of diet, smoking status, and physical activity). Also, whether the association is influenced by the number of spontaneous abortions or age at first spontaneous abortion is unclear.…”

“…Substantial evidence indicates that women with a history of spontaneous abortion have a greater risk of non-communicable diseases, including hypertension,7 cardiovascular diseases,7891011 and type 2 diabetes 71213. Evidence relating spontaneous abortion to mortality, however, is scant and inconsistent 141516. Major weaknesses of previous studies included retrospective assessment of spontaneous abortion in the long distant past, and lack of detailed data on various relevant confounders (eg, pre-pregnancy body mass index, history of other pregnancy complications) and mediating lifestyle factors (body mass index, quality of diet, smoking status, and physical activity).…”

Pregnancy Loss and Carotid Intima–Media Thickness in Mexican Women

“…In our study, a history of stillbirth more than doubled the odds of SCA (OR: 2.32; 95% CI, 1.03-5.21). Interestingly, a large population-based Japanese cohort 36 observed an inverse relation between the number of pregnancy losses and CVD. This difference could be attributed to differences between Western and Asian populations in behavioral responses to stressful events or obstetric care.…”