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Multiple miscarriages may increase risk for CVD
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Women who have experienced two or more miscarriages, consecutive or not, have a greater risk for developing CVD, according to a new study published in Heart.
The link between CVD and adverse pregnancy outcomes has been previously established. The American Heart Association mentions in its guidelines that preeclampsia, gestational diabetes and pregnancy-induced hypertension are major risk factors for premature CVD.
“CVD and recurrent miscarriage share risk factors such as smoking and obesity. Further, endothelial dysfunction has been hypothesized as the underlying link between recurrent miscarriage, preeclampsia, intrauterine growth restriction and future [CV] events. It is possible, therefore, that recurrent miscarriage is the first sign of subsequent CVD in women,” researchers wrote.
The retrospective cohort study was designed to evaluate whether miscarriage is a precursor to CVD. Using data from the Aberdeen Maternity and Neonatal Databank in Scotland, the researchers established four groups: women with nonconsecutive miscarriages; women with two consecutive miscarriages; women with three or more consecutive miscarriages; and women who had at least one live birth and no miscarriages. Scottish Morbidity Records were utilized to track the number of women who were later diagnosed with ischemic heart disease, cerebrovascular disease or other diseases of the circulatory system. Median follow-up was 17 years.
The researchers defined miscarriage as spontaneous loss of pregnancy before 24 weeks’ gestation.
Of the 60,105 women in the study, 49,579 had no history of miscarriage (mean maternal age, 28 years); 9,419 had a history of nonconsecutive miscarriages (mean maternal age, 27.5 years); 940 had a history of two consecutive miscarriages (mean maternal age, 30 years); and 167 had a history of three or more consecutive miscarriages (mean maternal age, 31.5 years).
Univariate analysis revealed an association between two or three consecutive miscarriages and most CV endpoints examined. The risk for ischemic heart disease, in particular, was increased in women with a history of two consecutive miscarriages (HR = 1.75; 95% CI, 1.22-2.52) and three or more consecutive miscarriages (HR = 3.18; 95% CI, 1.49-6.8).
In subgroup analyses, women with consecutive miscarriages had a lower risk for ischemic heart disease than women with two or more nonconsecutive miscarriages. According to the researchers, “this suggests that the number of events (two or more) is more important than the consecutive nature of events.”
Women with a history of miscarriage tended to have a higher BMI and reporting a history of current smoking.
Sensitivity analyses revealed similar patterns of risk, according to the results.
The researchers called for early identification of at-risk women so preventive measures can be taken to reduce the risk for CVD in women.
“We suggest that women who have experienced two or more miscarriages … whether consecutive or not, should be made aware of an increased [CV] risk and advised appropriate risk factor modifications. Work is needed to determine whether women with such a history will benefit from these screening and preventive interventions,” the researchers wrote. – by Tracey Romero
Disclosure: The researchers report no relevant financial disclosures.
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