Early or late pregnancy loss and development of clinical cardiovascular disease risk factors: a prospective cohort study

Horn, Julie; Tanz, Lauren J.; Stuart, Jennifer; Markovitz, Amanda R; Skurnik, Géraldine; Rimm, Eric B.; Missmer, Stacey A.; Rich‐Edwards, Janet W.

doi:10.1111/1471-0528.15452

Cited by 54 publications

(38 citation statements)

References 33 publications

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“… 5 6 Substantial evidence indicates that women with a history of spontaneous abortion have a greater risk of non-communicable diseases, including hypertension, 7 cardiovascular diseases, 7 8 9 10 11 and type 2 diabetes. 7 12 13 Evidence relating spontaneous abortion to mortality, however, is scant and inconsistent. 14 15 16 Major weaknesses of previous studies included retrospective assessment of spontaneous abortion in the long distant past, and lack of detailed data on various relevant confounders (eg, pre-pregnancy body mass index, history of other pregnancy complications) and mediating lifestyle factors (body mass index, quality of diet, smoking status, and physical activity).…”

Section: Introductionmentioning

confidence: 99%

Association of spontaneous abortion with all cause and cause specific premature mortality: prospective cohort study

Wang

Mínguez-Alarcón

Gaskins

et al. 2021

BMJ

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Objective To investigate the association of spontaneous abortion with the risk of all cause and cause specific premature mortality (death before the age of 70). Design Prospective cohort study. Setting The Nurses’ Health Study II (1993-2017), United States. Participants 101 681 ever gravid female nurses participating in the Nurses’ Health Study II. Main outcomes measures Lifetime occurrence of spontaneous abortion in pregnancies lasting less than 6 months, determined by biennial questionnaires. Hazard ratios and 95% confidence intervals for all cause and cause specific premature death according to the occurrence of spontaneous abortion, estimated with time dependent Cox proportional hazards models. Results During 24 years of follow-up, 2936 premature deaths were recorded, including 1346 deaths from cancer and 269 from cardiovascular disease. Crude all cause mortality rates were comparable for women with and without a history of spontaneous abortion (1.24 per 1000 person years in both groups) but were higher for women experiencing three or more spontaneous abortions (1.47 per 1000 person years) and for women reporting their first spontaneous abortion before the age of 24 (1.69 per 1000 person years). The corresponding age adjusted hazard ratios for all cause premature death during follow-up were 1.02 (95% confidence interval 0.94 to 1.11), 1.39 (1.03 to 1.86), and 1.27 (1.11 to 1.46), respectively. After adjusting for confounding factors and updated dietary and lifestyle factors, the occurrence of spontaneous abortion was associated with a hazard ratio of 1.19 (95% confidence interval 1.08 to 1.30) for premature mortality during follow-up. The association was stronger for recurrent spontaneous abortions (hazard ratio 1.59, 95% confidence interval 1.17 to 2.15 for three or more spontaneous abortions; 1.23, 1.00 to 1.50 for two; and 1.16, 1.05 to 1.28 for one compared with none), and for spontaneous abortions occurring early in a woman’s reproductive life (1.32, 1.14 to 1.53 for age ≤23; 1.16, 1.01 to 1.33 for ages 24-29; and 1.12, 0.98 to 1.28 for age ≥30 compared with none). When cause specific mortality was evaluated, the association of spontaneous abortion with premature death was strongest for deaths from cardiovascular disease (1.48, 1.09 to 1.99). Spontaneous abortion was not related to premature death from cancer (1.08, 0.94 to 1.24). Conclusions Spontaneous abortion was associated with an increased risk of premature mortality, particularly death from cardiovascular disease.

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Section: Introductionmentioning

confidence: 99%

Association of spontaneous abortion with all cause and cause specific premature mortality: prospective cohort study

Wang

Mínguez-Alarcón

Gaskins

et al. 2021

BMJ

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“…Pregnancy loss is the most common serious complication in early pregnancy, and at least one in three pregnancies end in a loss [4]. Pregnancy loss has been positively correlated to future risk of myocardial infarction, cerebral infarction [5], [6], hypertension, type 2 diabetes, and hypercholesterolemia [7], although the etiology and significance are largely unknown.…”

Section: Introductionmentioning

confidence: 99%

Pregnancy Loss and Cancer Risk: A Nationwide Observational Study

et al. 2019

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BackgroundCancer is the second leading cause of death worldwide. Few studies have investigated if recurrent pregnancy loss is associated with an increased risk of cancer. We aimed to assess whether pregnancy loss is associated with later cancer development.MethodsWe identified all invasive cancers after age 40, among all Danish women born between January 1957 and December 1972, ensuring a full reproductive history. Cases were matched by birth year 1:10 to cancer-free controls. Women were followed until the end of 2017. The number of pregnancy losses (miscarriages or still births) was correlated to long-term cancer risk using conditional logistic regression, providing odds ratios for specific cancers with different numbers of pregnancy losses, all adjusted for age, education, and other potential confounders.FindingsThe study included 28,785 women with cancer (mean age 48.7 [SD 5.0]) and 283,294 matched controls (mean age 48.6 [SD 5.0]). We found no overall association between pregnancy loss and later development of 11 site-specific types of cancer or cancer overall. Taking the sequence of pregnancy losses into account, primary recurrent pregnancy loss (three consecutive pregnancy losses without prior live birth) was associated with later overall cancer by an odds ratio of 1.27 (1.04–1.56). Secondary recurrent pregnancy loss showed no association to cancer.InterpretationPregnancy loss was not associated with later cancer development. Women with primary recurrent pregnancy loss had a borderline significant association to later cancer overall, this may be a chance finding.FundingOle Kirk's Foundation and Copenhagen University Hospital Rigshospitalet's Research Grant.

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“…Unlike normal pregnancies, which in the first trimester tend to have lower glucose values, in pregnant women with T2DM higher glucose spikes are generally observed and strict insulin therapy adjustment is required [12]. Taken together, the above findings regarding pregnancy in T2DM on a background of metabolic syndrome suggest that obesity and insulin resistance before and during the first trimester of pregnancy may greatly influence the risk of perinatal complications, more than glycaemic control [13,16,18].…”

Section: Discussionmentioning

confidence: 99%

Maternal-foetal complications in pregnancy: a retrospective comparison between type 1 and type 2 diabetes mellitus

Guarnotta

Mineo

Giacchetto

et al. 2021

BMC Pregnancy Childbirth

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Background The aim of the study was a retrospective comparison of the differences in maternal-foetal outcomes between women with type 1 and type 2 diabetes mellitus (T1DM and T2DM). Methods A cohort of 135 patients with pregestational diabetes, 73 with T1DM (mean age 29 ± 5 years) and 62 with T2DM (mean age 33 ± 6 years), in intensive insulin treatment throughout pregnancy were evaluated. Clinical and metabolic parameters and the prevalence of maternal and foetal complications were assessed. Results Women with T1DM showed lower pregestational BMI (p < 0.001), pregestational weight (p < 0.001), weight at delivery (p < 0.001), ∆_total_insulin requirement (IR) at the first, second and third trimesters (all p < 0.001) and higher weight gain during pregnancy (p < 0.001), pregestational HbA1c (p = 0.040), HbA1c in the first (p = 0.004), second (p = 0.020) and third (p = 0.010) trimesters compared to T2DM. Women with T1DM had a higher risk of macrosomia (p = 0.005) than T2DM, while women with T2DM showed higher prevalence of abortion (p = 0.037) than T1DM. At multivariate analysis, pregestational BMI and ∆_total_IR of the first trimester were independently associated with abortion in T2DM, while weight gain during pregnancy was independently associated with macrosomia in T1DM. Conclusion Women with T1DM have a higher risk of macrosomia than T2DM due to weight gain throughout pregnancy. By contrast, women with T2DM have a higher risk of spontaneous abortion than T1DM, due to pregestational BMI and ∆_total_IR in the first trimester.

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Early or late pregnancy loss and development of clinical cardiovascular disease risk factors: a prospective cohort study

Abstract: Pregnancy loss is associated with later maternal risk of hypertension, type 2 diabetes, and hypercholesterolemia.

Cited by 54 publications

References 33 publications

Association of spontaneous abortion with all cause and cause specific premature mortality: prospective cohort study

Association of spontaneous abortion with all cause and cause specific premature mortality: prospective cohort study

Pregnancy Loss and Cancer Risk: A Nationwide Observational Study

Maternal-foetal complications in pregnancy: a retrospective comparison between type 1 and type 2 diabetes mellitus

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