title: Pregnancy loss and later risk of atherosclerotic disease.
abstract: BACKGROUND
  Pregnancy losses and atherosclerotic disease may be etiologically linked through underlying pathology. We examined whether miscarriage and stillbirth increase later risk of myocardial infarction, cerebral infarction, and renovascular hypertension.
  
  
  RESULTS
  Among women pregnant at least once between 1977 and 2008, we identified a cohort of women with miscarriages, stillbirths, or live singleton births. These women were followed from the end of pregnancy for incident myocardial infarction, cerebral infarction, and renovascular hypertension. Using Poisson regression, we estimated incidence rate ratios for each of the outcomes by history of miscarriage and stillbirth. Among 1,031,279 women followed for >15,928,900 person-years, we identified 27 98 myocardial infarctions, 40 53 cerebral infarctions, and 1269 instances of renovascular hypertension. Women with stillbirths had 2.69 (95% confidence interval, 2.06-3.50), 1.74 (1.32-2.28), and 2.42 (1.59-3.69) times the rates of myocardial infarction, cerebral infarction, and renovascular hypertension, respectively, as women with no stillbirths. Compared with women with no miscarriages, women with miscarriages had 1.13 (1.03-1.24), 1.16 (1.07-1.25), and 1.20 (1.05-1.38) times the rates of these same outcomes, respectively; these associations were dose dependent, with each additional miscarriage increasing the rates of myocardial and cerebral infarction and renovascular hypertension by 9% (3% to 16%), 13% (7% to 19%), and 19% (9% to 30%), respectively. Associations were strongest in younger women (<35 years).
  
  
  CONCLUSIONS
  Pregnancy losses were associated with subsequent risks of myocardial infarction, cerebral infarction, and renovascular hypertension, consistent with either shared etiology or the initiation of pathological processes by a pregnancy loss leading to atherosclerosis.
authors.affiliation: Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark. fly@ssi.dk
authors.forename: Mattis Flyvholm
authors.initials: MF
authors.lastname: Ranthe
authors.forename: Elisabeth A Wreford
authors.initials: EA
authors.lastname: Andersen
authors.forename: Jan
authors.initials: J
authors.lastname: Wohlfahrt
authors.forename: Henning
authors.initials: H
authors.lastname: Bundgaard
authors.forename: Mads
authors.initials: M
authors.lastname: Melbye
authors.forename: Heather A
authors.initials: HA
authors.lastname: Boyd
mesh_terms: D000022:Abortion, Spontaneous / Q000175:diagnosis / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D050197:Atherosclerosis / Q000175:diagnosis / Q000453:epidemiology*; D002648:Child; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D050498:Live Birth / Q000453:epidemiology*; D008875:Middle Aged; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000453:epidemiology; D012307:Risk Factors; D050497:Stillbirth / Q000453:epidemiology*; D013997:Time Factors; D055815:Young Adult