Pregnancy Loss Associated With a Later Risk Of Atherosclerosis

March 29, 2013

COPENHAGEN, Denmark — Pregnant women who have a miscarriage or stillbirth delivery have a significantly increased risk of developing atherosclerosis, according to a new Danish analysis. In a study of more than one million women who became pregnant between 1977 and 2008, miscarriages increased the risk of MI and cerebrovascular infarction by 13% and 16%, respectively, compared with women without miscarriages. The risk of renal hypertension was increased 20% among those who had a miscarriage, while for those women who had a stillbirth, the risk of MI, cerebrovascular infarction, and renovascular hypertension was even higher.

"Overall, stillbirths were associated with greater risks than miscarriages, although in women with a history of four or more miscarriages, the rate increases were similar," write Dr Mattis Flyvholm Ranthe (Statens Serum Institute, Copenhagen, Denmark) and colleagues in their paper published online March 27, 2013 in Circulation [1]. The study was first reported by heartwire at the American College of Cardiology 2012 Scientific Sessions in Los Angeles, CA.

Compared with women who did not have a stillbirth, women who did had a 169% increased risk of MI, 74% increased risk of cerebral infarction, and 142% increased risk of developing renovascular hypertension.

For women who had a miscarriage, the effect on adverse outcomes appeared to be cumulative. For example, each additional miscarriage increased the incidence rate ratio of MI, cerebral infarction, and renovascular hypertension by 9%, 13%, and 19%, respectively. The incidence rate ratio for renovascular hypertension in women younger than 35 years old increased 55% compared with just 6% in women 35 years of age and older (compared with those without a miscarriage). Similarly, the rate of MI and cerebral infarction increased 35% and 42%, respectively, in younger women and 6% and 7%, respectively, in women 35 years and older.

The researchers note that female sex is generally considered protective against atherosclerosis, but the underlying systemic inflammation and vascular pathology "might link certain adverse pregnancy events with conditions that have atherosclerotic changes in the vascular bed." The finding that pregnancy losses are associated with later atherosclerotic events in three different organs suggests that the underlying common cause of these adverse events is unlikely to be organ-specific. They add that it is unknown if preeclampsia, a risk factor for ischemic heart disease and cerebral infarction, is causally involved.

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