Risk of Cardiovascular Disease Among Postmenopausal Women with Prior Pregnancy Loss: The Women’s Health Initiative

Parker et al. (Parker et al., 2014) make a valuable contribution to the literature linking pregnancy loss, through both miscarriage and stillbirth, with the development of coronary heart disease, the leading cause of death in women. Not only does their study confirm previous findings(Oliver-Williams, Heydon, Smith, & Wood, 2013) of an increased risk of coronary heart disease, but it does so in a diverse range of women, finding no interaction with racial group.

Importantly, it identifies that not only are women who suffer from multiple losses are at increased risk but women who experience a single sporadic miscarriage, who comprise the majority of women who have had a pregnancy loss, are also at greater risk. Surprisingly, however, risk did not increase with a greater numbers of miscarriages, which may be attributable to under-reporting of miscarriage.

In order to identify potential mechanisms underlying the association, the authors' correctly note that further work needs to address the role of biomarkers in the relationship between these two disparate events. In addition, further assessment of whether risk varies with age at pregnancy loss and whether risk varies with duration since pregnancy loss, initial evidence suggesting a greater risk in the first five years after pregnancy loss (Ranthe et al., 2013), is also required.

These results support the inclusion of pregnancy complications in the evaluation of cardiovascular disease risk in women, and targeting interventions to women with a history of pregnancy complications in order to reduce subsequent risk.

References

Oliver-Williams, C. T., Heydon, E. E., Smith, G. C. S., & Wood, A. M. (2013). Miscarriage and future maternal cardiovascular disease: a systematic review and meta-analysis. Heart (British Cardiac Society), 99(22), 1636-44. doi:10.1136/heartjnl-2012-303237

Parker, D. R., Lu, B., Sands-Lincoln, M., Kroenke, C. H., Lee, C. C., O'Sullivan, M., ... Eaton, C. B. (2014). Risk of Cardiovascular Disease Among Postmenopausal Women with Prior Pregnancy Loss: The Women's Health Initiative. Annals of Family Medicine, 12(4), 302-9. doi:10.1370/afm.1668

Ranthe, M. F., Andersen, E. A. W., Wohlfahrt, J., Bundgaard, H., Melbye, M., & Boyd, H. A. (2013). Pregnancy loss and later risk of atherosclerotic disease. Circulation, 127(17), 1775-82. doi:10.1161/CIRCULATIONAHA.112.000285

Competing interests: ?? None declared