Premium
Early or late pregnancy loss and development of clinical cardiovascular disease risk factors: a prospective cohort study
Author(s) -
Horn J,
Tanz LJ,
Stuart JJ,
Markovitz AR,
Skurnik G,
Rimm EB,
Missmer SA,
RichEdwards JW
Publication year - 2019
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.15452
Subject(s) - medicine , hazard ratio , pregnancy , prospective cohort study , obstetrics , type 2 diabetes , cohort study , diabetes mellitus , proportional hazards model , confidence interval , abortion , cohort , endocrinology , genetics , biology
Objective To assess the association between the outcome of a woman's first pregnancy and risk of clinical cardiovascular disease risk factors. Design Prospective cohort study. Setting and population Nurses’ Health Study II. Methods Multivariable‐adjusted Cox proportional hazards models were used to compute hazard ratios ( HR s) and 95% confidence intervals ( CI s) for the associations between first pregnancy outcome and hypertension, type 2 diabetes, and hypercholesterolemia. Main outcome measures Hypertension, type 2 diabetes, and hypercholesterolemia. Results Compared to women who reported a singleton live first birth, women with early spontaneous abortion (<12 weeks) had a greater rate of type 2 diabetes ( HR : 1.20; 95% CI : 1.07–1.34) and hypercholesterolemia ( HR : 1.06; 95% CI : 1.02–1.10), and a marginally increased rate of hypertension ( HR : 1.05, 95% CI : 1.00–1.11). Late spontaneous abortion (12–19 weeks) was associated with an increased rate of type 2 diabetes ( HR : 1.38; 95% CI : 1.14–1.65), hypercholesterolemia ( HR : 1.11; 95% CI : 1.03–1.19), and hypertension ( HR : 1.15; 95% CI : 1.05–1.25). The rates of type 2 diabetes ( HR : 1.45; 95% CI : 1.13–1.87) and hypertension ( HR : 1.15; 95% CI : 1.01–1.30) were higher in women who delivered stillbirth. In contrast, women whose first pregnancy ended in an induced abortion had lower rates of hypertension ( HR : 0.87; 95% CI : 0.84–0.91) and type 2 diabetes ( HR : 0.89; 95% CI : 0.79–0.99) than women with a singleton live birth. Conclusions Several types of pregnancy loss were associated with an increased rate of hypertension, type 2 diabetes, and hypercholesterolemia, which may provide novel insight into the pathways through which pregnancy outcomes and CVD are linked. Tweetable abstract Pregnancy loss is associated with later maternal risk of hypertension, type 2 diabetes, and hypercholesterolemia.