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Studies of novel cardiovascular disease (CVD) risk factors such as adverse pregnancy events are hampered by the nature of the events in question; life events cannot be studied in randomised controlled designs and the events of interest are often separated by decades. Consequently, epidemiological studies are important in furthering our understanding of such risk factors. Adverse pregnancy outcomes have been linked to an increased risk of later cardiovascular events. Most well established is the association with pre-eclampsia,1 but in 2003, Smith et al2 reported an association between miscarriage before first live birth and later risk of ischaemic heart disease in a cohort of 129 290 women. With the past decade's increased focus on CVD in women, risk factors specific to women, including adverse pregnancy events, have entered the spotlight. The American Heart Association's 2011 guidelines for the prevention of CVD in women specifically suggest that clinicians should ask focused questions about a history of pre-eclampsia and other pregnancy complications.3 The guidelines further call for new research to identify events during ‘periods of potential vulnerability’ in a woman's life that might influence her CVD risk.3 The time is therefore ripe to consider the impact of other adverse pregnancy events, including pregnancy losses.
Pregnancy losses have a wide range of underlying causes. Early miscarriages are often ascribed to major fetal chromosomal defects, while sporadic late miscarriages and recurrent miscarriages (both early and late) are often associated with one or more maternal risk factors, many of which overlap with traditional CVD risk factors: maternal infection, smoking, obesity, alcohol intake, diabetes, physical trauma, placental anomalies or dysfunction, maternal family history of recurrent miscarriage, systemic diseases characterised by immune or coagulation defects.4 As many as 25% of all women report having experienced a miscarriage; 10%–15% of recognised pregnancies are thought to …
Contributors MFR drafted the first version of this Editorial. HAB revised it and added important parts. MFR finalised the Editorial.
Competing interests MFR was employed by the Department of Epidemiology Research at Statens Serum Institute, Copenhagen, Denmark, from 2010 to 2013, and still collaborates with the department in connection with the research he conducted there. However, at the time of this submission, MFR is employed by Novo Nordisk A/S, Søborg, Denmark. Novo Nordisk played no role whatsoever in the preparation of this editorial.
Provenance and peer review Commissioned; internally peer reviewed.