Pregnancy loss and risk of cardiovascular disease: a prospective population-based cohort study (EPIC-Heidelberg)
- Correspondence to Dr Elham Kharazmi, German Cancer Research Center, Division of Cancer Epidemiology, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany; ;
Contributors EK: conception and design, data analysis and interpretation, manuscript writing and final approval of manuscript. LD: consultation for data analysis, commented on the manuscript. SR: administrative support and commented on the manuscript. RK: financial support, administrative support, provision of study material, commented on the manuscript and final approval of the manuscript. Name of the guarantor: Professor Rudolf Kaaks
- Accepted 27 September 2010
- Published Online First 1 December 2010
Objectives To examine whether pregnancy loss (miscarriage, abortion or stillbirth) is associated with a higher risk of myocardial infarction (MI) and stroke.
Design Population-based prospective cohort study.
Setting The European Prospective Investigation into Cancer and Nutrition (EPIC) cohort in Heidelberg, Germany (mean follow-up 10.8 years).
Participants All 11 518 women who had ever been pregnant (aged 35–66).
Results Out of the participants, 2876 (25%) had at least one miscarriage, 2053 (18%) had at least one abortion and 209 (2%) had at least one stillbirth. During the follow-up, 82 cases of MI and 112 of stroke (confirmed by medical records) occurred in these women. Each stillbirth increased the risk of MI 2.65 times (95% CI for age-adjusted HR 1.37 to 5.12; HR adjusted for age, smoking, alcohol consumption, body mass index, waist to hip ratio, physical activity, education, number of pregnancies, hypertension, hyperlipidaemia and diabetes mellitus: HR 2.32 95% CI 1.19 to 4.50, 95% CI). Recurrent miscarriage (>3) was associated with about nine times higher risk of MI (age-adjusted HR=8.90, 95% CI 3.18 to 24.90; fully adjusted HR 5.06, 95% CI 1.26 to 20.29). No significant association was found between abortion and MI or between any type of pregnancy loss and stroke.
Conclusions These results suggest that women who experience spontaneous pregnancy loss are at a substantially higher risk of MI later in life. Recurrent miscarriage and stillbirth are strong sex-specific predictors for MI and thus should be considered as important indicators for cardiovascular risk factors monitoring and preventive measures. Further research is suggested to elucidate underlying risk factors of pregnancy loss that at the same time strongly predispose to cardiovascular disease.
This research was conducted independently from the funders.
Funding This study was supported by the Deutsche Krebshilfe (grant No 70-488-Ha I), the Deutsche Forchungsgemeinschaft and Bundesministerium fuer Bildung und Forschung (BMBF).
Competing interests None.
Patient consent Obtained. The informed consent signed by the participants included an agreement for an analysis of non-cancer diseases.
Ethical approval The general cohort study protocol was approved by the responsible local ethics committee. Separate ethical approval was not required.
Provenance and peer review Not commissioned; externally peer reviewed.