Miscarriage and future maternal cardiovascular disease: a systematic review and meta-analysis

Context The 2011 American Heart Association guidelines identified pregnancy complications as a risk factor for cardiovascular disease in women. However, miscarriage was not mentioned within the guidelines, and there is no consensus on the association between miscarriage and future risk of cardiovascular disease. Objective To confirm or refute the association, a meta-analysis of published papers was conducted. Data sources PubMed, Web of Knowledge and Scopus were systematically searched to identify appropriate articles. Reference lists were then hand searched for additional relevant titles. Study Selection To be included, articles had to assess the association between miscarriage and subsequent cardiovascular disease in otherwise healthy women. Only women who had miscarriages were considered exposed. Pooled association measures, using random effects meta-analysis, were calculated for coronary heart disease and cerebrovascular disease. Publication bias and between-study heterogeneity were evaluated. Data Extraction Two authors individually reviewed all studies and extracted data on patient and study characteristics along with cardiovascular outcomes. Results 10 studies were identified, with 517 504 individuals included in the coronary heart disease meta-analysis and 134 461 individuals in the cerebrovascular disease analysis. A history of miscarriage was associated with a greater odds of developing coronary heart disease, OR (95% CI) =1.45 (1.18 to 1.78), but not with cerebrovascular disease, OR=1.11 (0.72 to 1.69). There was a strong association between recurrent miscarriage and coronary heart disease OR=1.99 (1.13 to 3.50). Evidence was found for moderate between-study heterogeneity and publication bias in the coronary heart disease analysis. Conclusions The meta-analysis indicates that a history of miscarriage or recurrent miscarriage is associated with a greater risk of subsequent coronary heart disease.

[1]  R. Burrow,et al.  Heart , 2013, Feline Soft Tissue and General Surgery.

[2]  S. Halpern,et al.  Chronic kidney disease in pregnancy. , 2013, International journal of obstetric anesthesia.

[3]  C. Ski,et al.  Systematic review of cardiovascular disease in women: assessing the risk. , 2011, Nursing & health sciences.

[4]  B. Psaty,et al.  Reproductive history and mortality from cardiovascular disease among women textile workers in Shanghai, China. , 2011, International journal of epidemiology.

[5]  D. Schust,et al.  Endocrinology and Recurrent Early Pregnancy Loss , 2011, Seminars in reproductive medicine.

[6]  A. Major,et al.  The problem of accelerated atherosclerosis in systemic lupus erythematosus: Insights into a complex co-morbidity , 2011, Thrombosis and Haemostasis.

[7]  J. Pell,et al.  Recurrent miscarriage is associated with a family history of ischaemic heart disease: a retrospective cohort study , 2011, BJOG : an international journal of obstetrics and gynaecology.

[8]  M. Evsen,et al.  Evaluation of the relationship between insulin resistance and recurrent pregnancy loss. , 2011, Ginekologia polska.

[9]  O. Dekkers,et al.  PCOS, coronary heart disease, stroke and the influence of obesity: a systematic review and meta-analysis. , 2011, Human reproduction update.

[10]  Rowena J Dolor,et al.  Effectiveness-based guidelines for the prevention of cardiovascular disease in women--2011 update: a guideline from the American Heart Association. , 2011, Journal of the American College of Cardiology.

[11]  Chung Y. Hsu,et al.  Hypertensive Disorders in Pregnancy and Preterm Delivery and Subsequent Stroke in Asian Women: A Retrospective Cohort Study , 2011, Stroke.

[12]  R. Kaaks,et al.  Pregnancy loss and risk of cardiovascular disease: a prospective population-based cohort study (EPIC-Heidelberg) , 2010, Heart.

[13]  Kent R Bailey,et al.  A systematic review and meta-analysis of pregnancy outcomes in patients with systemic lupus erythematosus and lupus nephritis. , 2010, Clinical journal of the American Society of Nephrology : CJASN.

[14]  K. Sutton-Tyrrell,et al.  Early or recurrent preterm birth and maternal cardiovascular disease risk. , 2010, Annals of epidemiology.

[15]  A. Stang.  Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses , 2010, European Journal of Epidemiology.

[16]  J. Langhoff‐Roos,et al.  Mortality of mothers from cardiovascular and non-cardiovascular causes following pregnancy complications in first delivery. , 2010, Paediatric and perinatal epidemiology.

[17]  D. Gladman,et al.  Atherosclerotic vascular events in a multinational inception cohort of systemic lupus erythematosus , 2010, Arthritis care & research.

[18]  R. Luoto,et al.  Miscarriage and risk of cardiovascular disease , 2010, Acta obstetricia et gynecologica Scandinavica.

[19]  P. Micco,et al.  Recurrent Pregnancy Loss and Thrombophilia , 2010, Journal of clinical medicine research.

[20]  J. Townend,et al.  Does miscarriage in an initial pregnancy lead to adverse obstetric and perinatal outcomes in the next continuing pregnancy? , 2008, BJOG : an international journal of obstetrics and gynaecology.

[21]  S. Yusuf,et al.  Cardiovascular sequelae of preeclampsia/eclampsia: a systematic review and meta-analyses. , 2008, American heart journal.

[22]  G. Booth,et al.  Increased Risk of Cardiovascular Disease in Young Women Following Gestational Diabetes Mellitus , 2008, Diabetes Care.

[23]  Patricia Davidson,et al.  More Similarities Than Differences: An International Comparison of CVD Mortality and Risk Factors in Women , 2007, Health care for women international.

[24]  Obesity and reproduction: an educational bulletin. , 2008, Fertility and sterility.

[25]  A. Hingorani,et al.  Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis , 2007, BMJ : British Medical Journal.

[26]  C. la Vecchia,et al.  Menstrual and reproductive factors and risk of non-fatal acute myocardial infarction in Italy. , 2007, European journal of obstetrics, gynecology, and reproductive biology.

[27]  B. Mulder,et al.  Outcome of pregnancy in women with congenital heart disease: a literature review. , 2007, Journal of the American College of Cardiology.

[28]  F. Weidinger,et al.  Endothelial function: a surrogate endpoint in cardiovascular studies? , 2007, Current pharmaceutical design.

[29]  R. Norman,et al.  Insulin resistance increases the risk of spontaneous abortion after assisted reproduction technology treatment. , 2007, The Journal of clinical endocrinology and metabolism.

[30]  S. Karumanchi,et al.  Endothelial Dysfunction: A Link Among Preeclampsia, Recurrent Pregnancy Loss, and Future Cardiovascular Events? , 2007, Hypertension.

[31]  L. Pasquier,et al.  Orphanet Journal of Rare Diseases , 2006 .

[32]  D. Triplett,et al.  Thrombophilias and recurrent pregnancy loss. , 2006, Seminars in reproductive medicine.

[33]  A. Birmingham,et al.  The Practice Committee of the American Society for Reproductive Medicine and the Practice Committee of the Society for Assisted Reproductive Technology , 2006 .

[34]  L. Jovanovič,et al.  Elevated pregnancy losses at high and low extremes of maternal glucose in early normal and diabetic pregnancy: evidence for a protective adaptation in diabetes. , 2005, Diabetes care.

[35]  M. Katz,et al.  Pregnancy outcome following recurrent spontaneous abortions. , 2005, European journal of obstetrics, gynecology, and reproductive biology.

[36]  A. Germain,et al.  Letter to the Editor Evidence Supporting a Beneficial Role for Long-Term l-Arginine Supplementation in High-Risk Pregnancies , 2004 .

[37]  J. Pell,et al.  Pregnancy complications and subsequent maternal cerebrovascular events: a retrospective cohort study of 119,668 births. , 2004, American journal of epidemiology.

[38]  Clarisse K. Akafomo,et al.  History of Fetal Loss and Other Adverse Pregnancy Outcomes in Relation to Subsequent Risk of Preterm Delivery , 2003, Maternal and Child Health Journal.

[39]  A. Germain,et al.  Evidence Supporting a Beneficial Role for Long-Term L-Arginine Supplementation in High-Risk Pregnancies. , 2004, Hypertension.

[40]  Bertram L Kasiske,et al.  Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. , 2003, Hypertension.

[41]  Eric J Topol,et al.  Prevalence of conventional risk factors in patients with coronary heart disease. , 2003, JAMA.

[42]  Changzhong Chen,et al.  Conception, early pregnancy loss, and time to clinical pregnancy: a population-based prospective study. , 2003, Fertility and sterility.

[43]  J. Pell,et al.  Spontaneous loss of early pregnancy and risk of ischaemic heart disease in later life: retrospective cohort study , 2003, BMJ : British Medical Journal.

[44]  M. E. Calle,et al.  Risk factors in miscarriage: a review. , 2002, European journal of obstetrics, gynecology, and reproductive biology.

[45]  C. Weinberg,et al.  Menstrual and reproductive risk factors for ischemic heart disease. , 1999, Epidemiology.

[46]  M. Greene,et al.  Spontaneous Abortions and Major Malformations in Women with Diabetes Mellitus , 1999, Seminars in reproductive endocrinology.

[47]  W. Frishman,et al.  Thyroid hormone and cardiovascular disease. , 1998, American heart journal.

[48]  C. Everett,et al.  Incidence and outcome of bleeding before the 20th week of pregnancy: prospective study from general practice , 1997, BMJ.

[49]  G. Hughes.  The antiphospholipid syndrome: ten years on , 1993, The Lancet.

[50]  B. Isaksson,et al.  The study of women in Gothenburg 1968-1969--a population study. General design, purpose and sampling results. , 2009, Acta medica Scandinavica.

[51]  W. Winkelstein,et al.  AGE TREND OF MORTALITY FROM CORONARY ARTERY DISEASE IN WOMEN AND OBSERVATIONS ON THE REPRODUCTIVE PATTERNS OF THOSE AFFECTED. , 1964, American heart journal.

[52]  A. Lilienfeld,et al.  Occurrence of pregnancy, abortion, and artificial menopause among women with coronary artery disease: a preliminary study. , 1958, Journal of chronic diseases.