Abstract 15621: History of Pregnancy Loss Predicts Coronary Heart Disease and Peripheral Vascular Disease in Post-Menopausal Women in the Women's Health Initiative (WHI)
Background: Metabolic and hormonal changes that occur during pregnancy loss may contribute to the development of coronary heart disease (CHD) in adulthood. We prospectively evaluated a history of pregnancy loss (stillbirths and miscarriages) and development of CHD, ischemic stroke, and peripheral vascular disease (PVD) in a cohort of postmenopausal women.
Methods: 78,001 postmenopausal women were evaluated at 40 WHI clinical centers throughout the US from 1993 - 1998. Baseline reproductive history, sociodemographic and CHD risk factors were assessed. We evaluated the odds ratio (OR) of having 1 or ≥ 2 miscarriages and ≥ 1 stillbirth controlling for baseline sociodemographic variables and CHD risk factors (i.e, early hypertension and diabetes, parity, aspirin use, and ACE-inhibitor use) using multiple logistic regression analyses.
Results: Of 78,001 women, 3,343 reported ≥ 1 stillbirths; 16,763 reported one miscarriage; and 8,448 reported ≥ 2 miscarriages. Multivariate-adjusted OR for ≥ 1 stillbirth was 1.33, 95% CI (1.12, 1.57) compared to none for CHD; for one miscarriage the OR was 1.19, 95% CI (1.09, 1.31) and for ≥ 2 miscarriages the OR was 1.21, 95% CI (1.08, 1.37) compared to none. For ischemic stroke, the multivariate OR for ≥1 stillbirth was 1.17, 95% CI (0.92, 1.49); for one miscarriage the OR=1.09, 95% CI (0.95, 1.24), and for ≥2 miscarriages was OR=1.03, 95% CI (0.87, 1.22) compared to none. For PVD, the multivariate OR for ≥ 1 stillbirth was OR=1.59, 95% CI (1.11, 2.29) compared to none; for one miscarriage the OR was 1.15, 95% CI (0.91, 1.45), and for ≥2 miscarriages was OR=1.16, 95% CI (0.87, 1.55) compared to none.
Conclusion: A history of stillbirths and miscarriages were independently and prospectively associated with CHD. Additionally, a history of stillbirths was independently associated with PVD. Neither stillbirths nor miscarriages were significantly associated with ischemic stroke. Further research into better understanding the pathophysiologic mechanisms behind the increased risk associated with CHD and PVD and appropriate use of primary prevention strategies to ameliorate the increased risk are needed.
- © 2011 by American Heart Association, Inc.