Recurrent pregnancy loss associated with increased cardiovascular morbidity

1. Women who experienced recurrent pregnancy loss were more likely to be hospitalized for cardiovascular morbidity later in life. 

2. Women who experienced recurrent pregnancy loss were more likely to subsequently experience simple and complex cardiovascular problems requiring invasive and non-invasive cardiovascular procedures. 

Evidence Rating Level: 2 (Good) 

Study Rundown: Atherosclerotic disease contributes to a significant number of deaths annually, and much attention is spent identifying potential risk factors. Previous research has identified certain obstetric conditions, such as preeclampsia and gestational diabetes, as risk factors for future development of cardiovascular disease, resulting in inclusion of both of these in the guidelines for cardiovascular disease risk evaluation in women. Recurrent pregnancy loss (RPL), defined as ≥2 consecutive pregnancy losses or ≥3 total losses, has numerous etiologies but thrombophilia and vascular etiologies are thought to play a large role. Prior work has demonstrated increased risk of myocardial infarction in women with a history of recurrent loss and prior research has even proposed a potential mechanism for increased risk of atherosclerotic disease among women with RPL. The present work is the first to explore the relationship between RPL and broadly defined cardiovascular and renal morbidities. This large population-based cohort study found that RPL is associated with increased likelihood of hospitalization for cardiovascular reasons. While women who experienced RPL were more likely to suffer from obesity, preeclampsia, diabetes, antiphospholipid syndrome and thrombophilia, RPL remained an independent predictor of subsequent cardiovascular morbidity requiring inpatient care. Results suggest it may be appropriate to inquire about RPL when evaluating a woman’s risk for cardiovascular morbidity.

The primary limitation of this study is a retrospective design. Future prospective studies should be performed to confirm the association observed herein, while bench work characterizing the mechanism connecting RPL and atherosclerosis would provide further insight.

Click to read the study in AJOG

Relevant Reading: Pregnancy loss and risk of cardiovascular disease: a prospective population-based cohort study

In-Depth [retrospective cohort]: This study evaluated the long-term risk of atherosclerotic cardiovascular and renal morbidity in women who experienced ≥2 consecutive pregnancy losses (n=6690) and women who did not experience RPL (n=92595). Outcomes of interest include hospitalizations for cardiovascular and renal morbidities as well as severity and type of cardiovascular morbidity.

Women who experienced RPL were more likely to be hospitalized for cardiovascular (OR 1.9, CI 1.6-2.3) and renal (OR 1.8, CI 1.01-3.07) morbidities. They were also more likely to be hospitalized for both simple and complex cardiovascular morbidities and to undergo both invasive and non-invasive cardiovascular procedures (p<0.001). After controlling for known and potential confounders, RPL was independently associated with cardiovascular (OR 1.3, CI 1.1-1.5) but not renal hospitalizations.

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Image: PD 

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