Donna R Parker1, Bing Lu2, Megan Sands-Lincoln2, Candyce H Kroenke2, Cathy C Lee2, Mary O'Sullivan2, Hannah L Park2, Nisha Parikh2, Robert S Schenken2, Charles B Eaton2. 1. Departments of Family Medicine and Epidemiology, Alpert Medical School of Brown University, Providence, Rhode Island (Parker, Eaton); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island (Parker, Eaton); Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts (Lu); University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, Pennsylvania (Sands-Lincoln); Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas (Brzyski, Schenken); Kaiser Permanente Division of Research, Oakland, California (Kroenke); Division of Geriatric Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (Lee); University of Miami, Miller School of Medicine, Department of Obstetrics/Gynecology, Miami, Florida (O'Sullivan); UC Irvine School of Medicine, Department of Epidemiology, Irvine, California (Park); John A. Burns School of Medicine (JABSOM), University of Hawaii, Honolulu, Hawaii (Parikh). Donna_Parker@Brown.edu. 2. Departments of Family Medicine and Epidemiology, Alpert Medical School of Brown University, Providence, Rhode Island (Parker, Eaton); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island (Parker, Eaton); Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts (Lu); University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, Pennsylvania (Sands-Lincoln); Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas (Brzyski, Schenken); Kaiser Permanente Division of Research, Oakland, California (Kroenke); Division of Geriatric Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (Lee); University of Miami, Miller School of Medicine, Department of Obstetrics/Gynecology, Miami, Florida (O'Sullivan); UC Irvine School of Medicine, Department of Epidemiology, Irvine, California (Park); John A. Burns School of Medicine (JABSOM), University of Hawaii, Honolulu, Hawaii (Parikh).
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 postmenopausal 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.
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 postmenopausal 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.
Authors: J David Curb; Anne McTiernan; Susan R Heckbert; Charles Kooperberg; Janet Stanford; Michael Nevitt; Karen C Johnson; Lori Proulx-Burns; Lisa Pastore; Michael Criqui; Sandra Daugherty Journal: Ann Epidemiol Date: 2003-10 Impact factor: 3.797
Authors: Patricia K Agatisa; Roberta B Ness; James M Roberts; Joseph P Costantino; Lewis H Kuller; Margaret K McLaughlin Journal: Am J Physiol Heart Circ Physiol Date: 2004-04 Impact factor: 4.733
Authors: Robert D Langer; Emily White; Cora E Lewis; Jane M Kotchen; Susan L Hendrix; Maurizio Trevisan Journal: Ann Epidemiol Date: 2003-10 Impact factor: 3.797
Authors: Marcia L Stefanick; Barbara B Cochrane; Judith Hsia; David H Barad; James H Liu; Susan R Johnson Journal: Ann Epidemiol Date: 2003-10 Impact factor: 3.797
Authors: Umesh N Khot; Monica B Khot; Christopher T Bajzer; Shelly K Sapp; E Magnus Ohman; Sorin J Brener; Stephen G Ellis; A Michael Lincoff; Eric J Topol Journal: JAMA Date: 2003-08-20 Impact factor: 56.272
Authors: Yamnia I Cortés; Nisha Parikh; Matthew A Allison; Michael H Criqui; Natalie Suder; Emma Barinas-Mitchell; Christina L Wassel Journal: J Womens Health (Larchmt) Date: 2018-12-01 Impact factor: 2.681
Authors: Philip S Hall; Gregory Nah; Barbara V Howard; Cora E Lewis; Matthew A Allison; Gloria E Sarto; Molly E Waring; Lisette T Jacobson; JoAnn E Manson; Liviu Klein; Nisha I Parikh Journal: J Am Coll Cardiol Date: 2017-05-23 Impact factor: 24.094
Authors: Philip S Hall; Gregory Nah; Eric Vittinghoff; Donna R Parker; JoAnn E Manson; Barbara V Howard; Gloria E Sarto; Margery L Gass; Shawnita M Sealy-Jefferson; Elena Salmoirago-Blotcher; Marcia L Stefanick; Aladdin H Shadyab; Linda V Van Horn; Ki Park; Nisha I Parikh Journal: Am J Cardiol Date: 2019-02-22 Impact factor: 2.778
Authors: Geoffrey H Tison; Robert Avram; Gregory Nah; Liviu Klein; Barbara V Howard; Matthew A Allison; Ramon Casanova; Rachael H Blair; Khadijah Breathett; Randi E Foraker; Jeffrey E Olgin; Nisha I Parikh Journal: Can J Cardiol Date: 2021-08-13 Impact factor: 5.223
Authors: Nisha I Parikh; Rebecca P Jeppson; Jeffrey S Berger; Charles B Eaton; Candyce H Kroenke; Erin S LeBlanc; Cora E Lewis; Eric B Loucks; Donna R Parker; Eileen Rillamas-Sun; Kelli K Ryckman; Molly E Waring; Robert S Schenken; Karen C Johnson; Anna-Karin Edstedt-Bonamy; Matthew A Allison; Barbara V Howard Journal: Circulation Date: 2016-04-19 Impact factor: 29.690
Authors: Carrie J Nobles; Pauline Mendola; Sunni L Mumford; Ashley I Naimi; Edwina H Yeung; Keewan Kim; Hyojun Park; Brian Wilcox; Robert M Silver; Neil J Perkins; Lindsey Sjaarda; Enrique F Schisterman Journal: Hypertension Date: 2018-04-02 Impact factor: 10.190
Authors: J Horn; L J Tanz; J J Stuart; A R Markovitz; G Skurnik; E B Rimm; S A Missmer; J W Rich-Edwards Journal: BJOG Date: 2018-09-23 Impact factor: 6.531