Can pregnancy loss predict cardiovascular disease in post-menopausal women?

Post-menopausal women may be at greater risk for cardiovascular diseases if they have ever experienced miscarriage or stillbirth, according to a study published in the July issue of Annals of Family Medicine.

Using the Women’s Health Initiative cohort enrolled between 1993 and 1998, the research team followed 77,701 women to determine their health status. History of stillbirth or miscarriage were self-reported.

After a mean follow-up of 7.7 years, 2.7 percent of participants were reported to have had clinical MI events, 1.9 percent experienced ischemic stroke events, and 3.1 percent experienced coronary heart disease events. Angina and revascularization occurred in 5.7 percent and 37.9 percent of those who experienced coronary heart disease events, respectively.

Lead author Donna R. Parker, ScD, of Memorial Hospital of Rhode Island in Pawtucket, and colleagues wrote that 2.2 percent of women in the cohort reported a history of stillbirth, 30.3 percent reported a history of miscarriage and 2.2 percent reported a history of both stillbirth and miscarriage.

Parker et al noted that of the participants in their study, women who had a history of stillbirth only were likely to have been pregnant more frequently, were older and less likely to drink. On the other hand combination pregnancy loss showed other risk factors for cardiovascular and coronary heart disease in post-menopause, including higher body mass index, high blood pressure, early hypertension, smoking, diabetes and depression.

While they reported no findings between increased risk for stroke and pregnancy loss, they did report the odds ratio for the pregnancy loss and risk for coronary heart disease appeared to be 1.19 for one miscarriage, 1.18 for two or more miscarriages and 1.27 for stillbirths compared to women who had given live birth.

This data appear to be consistent with other studies in the field. However among limitations noted by Parker et al was a lack of biomarker data and the use of self-reported data on miscarriage. Biomarker data provide more concrete data on body processes involved in the development of disease. Lack of that data in this study makes direct associations difficult.

While rates of stillbirth were consistent with other studies, as Parker et al wrote, self-reporting may not cover early spontaneous miscarriages that the patient was unaware of. Information was likewise unavailable for age at time of pregnancy and length of gestation prior to loss.

Parker et al wrote that while their findings were inconclusive, they recommend surveillance of women with history of pregnancy loss for increased risks for cardiovascular disease.