Risk of cardiovascular disease among postmenopausal women with prior pregnancy loss

The women's health initiative

Donna R. Parker, Bing Lu, Megan Sands-Lincoln, Candyce H. Kroenke, Cathy C. Lee, Mary O'Sullivan, Hannah L. Park, Nisha Parikh, Robert S. Schenken, Charles B. Eaton

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

PURPOSE Metabolic, hormonal, and hemostatic changes associated with pregnancy loss (stillbirth and miscarriage) may contribute to the development of cardiovascular disease (CVD) in adulthood. This study evaluated prospectively the association between a history of pregnancy loss and CVD in a cohort of post-menopausal women. METHODS Postmenopausal women (77,701) were evaluated from 1993-1998. Information on baseline reproductive history, sociodemographic, and CVD risk factors were collected. The associations between 1 or 2 or more miscarriages and 1 or more stillbirths with occurrence of CVD were evaluated using multiple logistic regression. RESULTS Among 77,701 women in the study sample, 23,538 (30.3%) reported a history of miscarriage; 1,670 (2.2%) reported a history of stillbirth; and 1,673 (2.2%) reported a history of both miscarriage and stillbirth. Multivariable-adjusted odds ratio (OR) for coronary heart disease (CHD) for 1 or more stillbirths was 1.27 (95% CI, 1.07-1.51) compared with no stillbirth; for women with a history of 1 miscarriage, the OR = 1.19 (95% CI, 1.08-1.32); and for 2 or more miscarriages the OR = 1.18 (95% CI, 1.04-1.34) compared with no miscarriage. For ischemic stroke, the multivariable odds ratio for stillbirths and miscarriages was not significant. CONCLUSIONS Pregnancy loss was associated with CHD but not ischemic stroke. Women with a history of 1 or more stillbirths or 1 or more miscarriages appear to be at increased risk of future CVD and should be considered candidates for closer surveillance and/or early intervention; research is needed into better understanding the pathophysiologic mechanisms behind the increased risk of CVD associated with pregnancy loss.

Original languageEnglish
Pages (from-to)302-309
Number of pages8
JournalAnnals of Family Medicine
Volume12
Issue number4
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Women's Health
Spontaneous Abortion
Stillbirth
Cardiovascular Diseases
Pregnancy
Odds Ratio
Reproductive History
Coronary Disease
Stroke
Hemostatics
Logistic Models
Research

Keywords

  • Cardiovascular diseases
  • Coronary disease
  • Miscarriage
  • Stillbirth
  • Women's health

ASJC Scopus subject areas

  • Family Practice

Cite this

Parker, D. R., Lu, B., Sands-Lincoln, M., Kroenke, C. H., Lee, C. C., O'Sullivan, M., ... Eaton, C. B. (2014). Risk of cardiovascular disease among postmenopausal women with prior pregnancy loss: The women's health initiative. Annals of Family Medicine, 12(4), 302-309. https://doi.org/10.1370/afm.1668

Risk of cardiovascular disease among postmenopausal women with prior pregnancy loss : The women's health initiative. / Parker, Donna R.; Lu, Bing; Sands-Lincoln, Megan; Kroenke, Candyce H.; Lee, Cathy C.; O'Sullivan, Mary; Park, Hannah L.; Parikh, Nisha; Schenken, Robert S.; Eaton, Charles B.

In: Annals of Family Medicine, Vol. 12, No. 4, 01.01.2014, p. 302-309.

Research output: Contribution to journalArticle

Parker, DR, Lu, B, Sands-Lincoln, M, Kroenke, CH, Lee, CC, O'Sullivan, M, Park, HL, Parikh, N, Schenken, RS & Eaton, CB 2014, 'Risk of cardiovascular disease among postmenopausal women with prior pregnancy loss: The women's health initiative', Annals of Family Medicine, vol. 12, no. 4, pp. 302-309. https://doi.org/10.1370/afm.1668
Parker, Donna R. ; Lu, Bing ; Sands-Lincoln, Megan ; Kroenke, Candyce H. ; Lee, Cathy C. ; O'Sullivan, Mary ; Park, Hannah L. ; Parikh, Nisha ; Schenken, Robert S. ; Eaton, Charles B. / Risk of cardiovascular disease among postmenopausal women with prior pregnancy loss : The women's health initiative. In: Annals of Family Medicine. 2014 ; Vol. 12, No. 4. pp. 302-309.
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abstract = "PURPOSE Metabolic, hormonal, and hemostatic changes associated with pregnancy loss (stillbirth and miscarriage) may contribute to the development of cardiovascular disease (CVD) in adulthood. This study evaluated prospectively the association between a history of pregnancy loss and CVD in a cohort of post-menopausal women. METHODS Postmenopausal women (77,701) were evaluated from 1993-1998. Information on baseline reproductive history, sociodemographic, and CVD risk factors were collected. The associations between 1 or 2 or more miscarriages and 1 or more stillbirths with occurrence of CVD were evaluated using multiple logistic regression. RESULTS Among 77,701 women in the study sample, 23,538 (30.3{\%}) reported a history of miscarriage; 1,670 (2.2{\%}) reported a history of stillbirth; and 1,673 (2.2{\%}) reported a history of both miscarriage and stillbirth. Multivariable-adjusted odds ratio (OR) for coronary heart disease (CHD) for 1 or more stillbirths was 1.27 (95{\%} CI, 1.07-1.51) compared with no stillbirth; for women with a history of 1 miscarriage, the OR = 1.19 (95{\%} CI, 1.08-1.32); and for 2 or more miscarriages the OR = 1.18 (95{\%} CI, 1.04-1.34) compared with no miscarriage. For ischemic stroke, the multivariable odds ratio for stillbirths and miscarriages was not significant. CONCLUSIONS Pregnancy loss was associated with CHD but not ischemic stroke. Women with a history of 1 or more stillbirths or 1 or more miscarriages appear to be at increased risk of future CVD and should be considered candidates for closer surveillance and/or early intervention; research is needed into better understanding the pathophysiologic mechanisms behind the increased risk of CVD associated with pregnancy loss.",
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AB - PURPOSE Metabolic, hormonal, and hemostatic changes associated with pregnancy loss (stillbirth and miscarriage) may contribute to the development of cardiovascular disease (CVD) in adulthood. This study evaluated prospectively the association between a history of pregnancy loss and CVD in a cohort of post-menopausal women. METHODS Postmenopausal women (77,701) were evaluated from 1993-1998. Information on baseline reproductive history, sociodemographic, and CVD risk factors were collected. The associations between 1 or 2 or more miscarriages and 1 or more stillbirths with occurrence of CVD were evaluated using multiple logistic regression. RESULTS Among 77,701 women in the study sample, 23,538 (30.3%) reported a history of miscarriage; 1,670 (2.2%) reported a history of stillbirth; and 1,673 (2.2%) reported a history of both miscarriage and stillbirth. Multivariable-adjusted odds ratio (OR) for coronary heart disease (CHD) for 1 or more stillbirths was 1.27 (95% CI, 1.07-1.51) compared with no stillbirth; for women with a history of 1 miscarriage, the OR = 1.19 (95% CI, 1.08-1.32); and for 2 or more miscarriages the OR = 1.18 (95% CI, 1.04-1.34) compared with no miscarriage. For ischemic stroke, the multivariable odds ratio for stillbirths and miscarriages was not significant. CONCLUSIONS Pregnancy loss was associated with CHD but not ischemic stroke. Women with a history of 1 or more stillbirths or 1 or more miscarriages appear to be at increased risk of future CVD and should be considered candidates for closer surveillance and/or early intervention; research is needed into better understanding the pathophysiologic mechanisms behind the increased risk of CVD associated with pregnancy loss.

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