The risk of cardiovascular diseases after miscarriage, stillbirth, and induced abortion: a systematic review and meta-analysis

Abstract

Aims Miscarriage and stillbirth has been included in cardiovascular disease (CVD) risk guidelines, however heterogeneity in exposures and outcomes and the absence of reviews assessing induced abortion, prevented comprehensive assessment. We aimed to perform a systematic review and meta-analysis of the risk of cardiovascular diseases for women with prior pregnancy loss (miscarriage, stillbirth and induced abortion). Methods and Results Observational studies reporting risk of CVD, coronary heart disease (CHD) and stroke in women with pregnancy loss were selected after searching MEDLINE, Scopus, CINAHL, Web of Knowledge and Cochrane Library (to January 2020). Data were extracted, and study quality assessed using the Newcastle-Ottawa Scale. Pooled relative risk (RR) and 95% confidence intervals (CI) were calculated using inverse variance weighted random-effects meta-analysis. Twenty-two studies involving 4,337,683 women were identified. Seven studies were good quality, seven were fair and eight were poor. Recurrent miscarriage was associated with a higher CHD risk (RR = 1.37, 95%CI:1.12-1.66). One or more stillbirths was associated with a higher CVD (RR = 1.41, 95%CI:1.09-1.82), CHD (RR = 1.51, 95%CI:1.04-1.29) and stroke risk (RR = 1.33, 95%CI:1.03-1.71). Recurrent stillbirth was associated with a higher CHD risk (RR = 1.28, 95%CI:1.18-1.39).). One or more abortions was associated with a higher CVD (RR = 1.04, 95%CI:1.02-1.07), as was recurrent abortion (RR = 1.09, 95%CI:1.05-1.13). Conclusion Women with previous pregnancy loss are at a higher CVD, CHD and stroke risk. Early identification and risk factor management is recommended. Further research is needed to understand CVD risk after abortion.

Reproductive factors and cardiometabolic disease among middle-aged and older women: a nationwide study from CHARLS

“…In addition, we have identified a risk-conferring impact of history of abortion on the odds of cardiometabolic disease. Evidence from a recent meta-analysis showed that women with previous pregnancy loss were at high risk for cardiovascular disease and stroke in later life ( 36 ), which consolidated our observations.…”

Cardiovascular complications following medical termination of pregnancy: An updated review

“…However, the strengths of this study are: (1) Having a strict inclusion criterion for each clinical entity; and (2) Evidence-based detailing on the clinical profile and the outcome of each described complication. As per the authors’ knowledge, there are previous studies done including Kyriacou et al [ 3 ] who have reported that women with previous pregnancy loss, following a miscarriage, stillbirth, and induced abortion, are at higher risk of coronary heart disease and stroke. However, this is the first review detailing the clinical profile, imaging details, complications, and outcomes of the various CVD complications following MTP.…”

“…Therefore, having an understanding of the female specific risk stratification and prevention is important. Recent CVD risk guidelines have included miscarriage and stillbirth as risk factors for women[ 3 ]. Because of the changing times and laws, we must highlight various CVD complications which are associated with the termination of pregnancy[ 4 ].…”

Diabetic and hypertensive disorders following early pregnancy loss: a systematic review and meta-analysis

“…Past reviews have attempted to elucidate the association between a prior early pregnancy loss and the subsequent development of cardiovascular disease, 77 , 78 , 79 without attention to intermediary factors, such as diabetic and hypertensive disorders. This review undertook a comprehensive review of the findings from observational studies that investigated the association between a prior early pregnancy loss and the subsequent risk of developing a diabetic or hypertensive disorders, some of which are modifiable and can thereby prevent the onset of cardiovascular disease.…”