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Stillbirth or miscarriage history increases risk of cardiovascular disease

Robin Wulffson MD's picture
miscarriage, stillbirth, cardiovascular disease, atherosclerosis

Pregnancy loss either from miscarriage or stillbirth is a devastating event for a woman; however, a new study has reported that it may also preclude the devastation of atherosclerotic disease. Lead researcher Dr Mattis F Ranthe who is affiliated with the Statens Serum Institute, Copenhagen, Denmark presented the findings on November 7 at the American Heart Association scientific meeting, which ran from November 3 through November 7 at the Los Angeles Convention Center.

The study group comprised more than 1 million Danish women; thus, it was the largest study of its kind to evaluate atherosclerotic disease following pregnancy loss from either a miscarriage or stillbirth. In Denmark, all citizens are assigned a 10-digit personal-identification number at birth, and this number is used in a variety of health registries, including those that track pregnancies. The researchers examined women over the age of 12 in the study period ranging from 1997 to 2008. These women either had to have given birth to a live single infant or suffered a miscarriage or stillbirth. The women were followed an average of 15 years for a myocardial infarction, cerebral infarction (stroke), or renovascular hypertension (high blood pressure due to damaged kidney blood vessels). The data were adjusted for calendar period, current age, and number of live births; for a subgroup of the women, information on smoking, the use of lipid-lowering medications, and the use of antihypertensive drugs was available.

Of the 1,031,279 women, 842,616 of whom experienced live births only. Among the women who suffered a miscarriage or stillbirth, 151,880 experienced one miscarriage, 28,398 suffered two, 5,979 lost three pregnancies, 2,406 women suffered four or more miscarriages, and 8,191 had one or more stillbirths. During the follow-up period there were 2,798 myocardial infarctions, 4,053 cerebral infarctions and 1,269 diagnoses of renovascular hypertension among the study group.

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For all three adverse cardiovascular events, the risk is increased roughly twofold if the woman had a history of any stillbirth. If the woman had ever experienced a miscarriage, the risk was less; however, it was statistically significant for all three adverse events. The risk was higher with an increasing number of miscarriages even after adjusting for risk factors such as smoking or diabetes. In addition, the risk associated with miscarriage was highest among younger women. For women who had suffered four or more miscarriages or a previous stillbirth, there was an approximately twofold increase in the risk of all three adverse events.

The investigators concluded that their study, taken together with previous studies, implies a possible common underlying pathology linking pregnancy losses and atherosclerosis.

Reference: American Heart Association scientific meeting

Take home message:
This study should alert women who have suffered a stillbirth or miscarriage and their physicians that they may be at increased risk of cardiovascular. A family history of cardiovascular disease should also be taken into account. Smoking and other poor lifestyle choices are risk factors for stillbirth, miscarriage, and cardiovascular disease. A woman who suffers pregnancy loss and has made poor lifestyle choices should take steps to improve them. If a woman is diabetic, she should attempt to keep her diabetes under the best possible control as well as adopting healthy lifestyle choices.

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