Miscarriages, Stillbirths Raise Risk of Cardiovascular Disease

MedicalResearch.com Interview with:
Donna Parker, Sc.D., FAHA

Director of Community Health and Research
Center for Primary Care and Prevention
Memorial Hospital of RI
Pawtucket, RI 02860

MedicalResearch: What are the main findings of the study?

Answer: The main findings of the study are that women with a history of one or more miscarriages or one or more stillbirths appear to be at increased risk of cardiovascular disease. We found that the multivariable adjusted odds ratio for coronary heart disease for one or more stillbirths was 1.27 (95 percent CI, 1.07-1.51) compared with no stillbirth; for women with a history of one miscarriage, the odds ratio was 1.19 (95 percent CI, 1.08-1.32); and for women with a history of two or more miscarriages, the odds ratio was 1.18 (95 percent CI, 1.04-1.34) compared with no miscarriage. However, we did not find a significant association of ischemic stroke and pregnancy loss. The association between pregnancy loss and CHD appeared to be independent of hypertension, body mass index, waist-to-hip ratio and white blood cell count.

MedicalResearch: Were any of the findings unexpected?

Answer: No, these findings were not unexpected and are consistent with the limited studies that have been conducted in the past.

MedicalResearch: What should clinicians and patients take away from your report?

Answer:Until recently, prenatal loss was not routinely considered to be a risk factor for development of future CVD. The American Heart Association recently recommended adding reproductive history of pregnancy loss as a risk factor for CHD. Given that 15% of CVD events in women occur in the absence of conventional risk factors, reproductive history of pregnancy loss may be a potentially clinically useful predictive marker of CVD risk. Our findings, although not conclusive, suggest that women with a history of miscarriage or a single stillbirth may be at increased CVD risk and should be considered candidates for closer surveillance and/or early intervention by their primary care physician so that risk factors can be carefully monitored and controlled (including monitoring of CVD risk factors – diabetes, hypertension, cholesterol, obesity, smoking, and diet).

MedicalResearch: What recommendations do you have for future research as a result of this study?

Answer: Recommendations include examining the association prospectively since this was an observational study and also to examine the association with early and late pregnancy. Additionally, given the shared cause for pregnancy loss and CHD, further investigation is needed into better understanding the pathophysiologic mechanisms behind the increased risk (i.e., changes in endothelial function, insulin resistance, inflammation,and hypercoagulable states) and to also examine biomarker data so that we can examine potential biologic pathways to help us further understand this association.

Citation:

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, and Charles B. Eaton

Ann Fam Med July/August 2014 12:302-309; doi:10.1370/afm.1668