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Pregnancy Loss and Risk of CVD: Nurses’ Health Study II
Quick Take
- Pregnancy loss is an independent early marker of cardiovascular disease.
Study Questions:
What is the association of pregnancy loss with the incidence of cardiovascular disease (CVD), and how is this mediated by subsequent metabolic disorders?
Methods:
This study used the Nurses’ Health Study II (1993–2017) to follow 95,465 ever-gravid women to determine Cox proportional hazard ratios (HRs) of CVD (including coronary heart disease and stroke) according to the occurrence of pregnancy loss. Intermediating effects of subsequent diabetes, hypertension, or hypercholesterolemia were studied.
Results:
Person-years of follow-up were 2,205,392 (mean 23.1 years); CVD was documented in 2,225 women (2.3%). The adjusted HR of CVD among women with prior pregnancy loss was 1.21 (95% confidence interval [CI], 1.10-1.33); HR of coronary heart disease was 1.20 (95% CI, 1.07-1.35) and stroke was 1.23 (95% CI, 1.04-1.44). CVD risk increased with higher number of pregnancy losses and was highest for pregnancy losses that occurred at younger maternal ages. The association between pregnancy loss and CVD was explained by subsequent development of hypertension, hypercholesterolemia, and type 2 diabetes in <1.8% of cases.
Conclusions:
Pregnancy losses were associated with increased risk of CVD, and this was independent of subsequent development of hypertension, hypercholesterolemia, and type 2 diabetes.
Perspective:
Spontaneous pregnancy loss occurs most commonly prior to 20 weeks of gestation and is estimated to occur in 12-24% of clinically recognized pregnancies. Prior studies have reported an association between pregnancy loss and subsequent risk of CVD; however, the contribution of intervening development of traditional CVD risk factors has been unclear. This study demonstrated that hypertension, hypercholesterolemia, and diabetes only mediated a small proportion of CVD. Future studies are needed to further determine the mechanisms underlying the association between pregnancy loss and CVD. Clinically, taking a reproductive history, including a history of pregnancy loss, can help identify patients at increased risk for CVD.
Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Homozygous Familial Hypercholesterolemia, Hypertension
Keywords: Abortion, Spontaneous, Cardiovascular Diseases, Coronary Disease, Diabetes Mellitus, Type 2, Hypercholesterolemia, Hypertension, Infant, Newborn, Maternal Age, Metabolic Syndrome, Pregnancy, Primary Prevention, Reproductive History, Risk Factors, Stillbirth, Stroke, Women, Vascular Diseases
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