title: Risk of cardiovascular disease among postmenopausal women with prior pregnancy loss: the women's health initiative.
abstract: OBJECTIVE
  Metabolic, hormonal, and hemostatic changes associated with pregnancy loss (stillbirth and miscarriage) may contribute to the development of cardiovascular disease (CVD) in adulthood. This study evaluated prospectively the association between a history of pregnancy loss and CVD in a cohort of postmenopausal women.
  
  
  METHODS
  Postmenopausal women (77,701) were evaluated from 1993-1998. Information on baseline reproductive history, sociodemographic, and CVD risk factors were collected. The associations between 1 or 2 or more miscarriages and 1 or more stillbirths with occurrence of CVD were evaluated using multiple logistic regression.
  
  
  RESULTS
  Among 77,701 women in the study sample, 23,538 (30.3%) reported a history of miscarriage; 1,670 (2.2%) reported a history of stillbirth; and 1,673 (2.2%) reported a history of both miscarriage and stillbirth. Multivariable-adjusted odds ratio (OR) for coronary heart disease (CHD) for 1 or more stillbirths was 1.27 (95% CI, 1.07-1.51) compared with no stillbirth; for women with a history of 1 miscarriage, the OR=1.19 (95% CI, 1.08-1.32); and for 2 or more miscarriages the OR=1.18 (95% CI, 1.04-1.34) compared with no miscarriage. For ischemic stroke, the multivariable odds ratio for stillbirths and miscarriages was not significant.
  
  
  CONCLUSIONS
  Pregnancy loss was associated with CHD but not ischemic stroke. Women with a history of 1 or more stillbirths or 1 or more miscarriages appear to be at increased risk of future CVD and should be considered candidates for closer surveillance and/or early intervention; research is needed into better understanding the pathophysiologic mechanisms behind the increased risk of CVD associated with pregnancy loss.
authors.affiliation: Departments of Family Medicine and Epidemiology, Alpert Medical School of Brown University, Providence, Rhode Island (Parker, Eaton); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island (Parker, Eaton); Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts (Lu); University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, Pennsylvania (Sands-Lincoln); Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas (Brzyski, Schenken); Kaiser Permanente Division of Research, Oakland, California (Kroenke); Division of Geriatric Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (Lee); University of Miami, Miller School of Medicine, Department of Obstetrics/Gynecology, Miami, Florida (O'Sullivan); UC Irvine School of Medicine, Department of Epidemiology, Irvine, California (Park); John A. Burns School of Medicine (JABSOM), University of Hawaii, Honolulu, Hawaii (Parikh). Donna_Parker@Brown.edu.
authors.forename: Donna R
authors.initials: DR
authors.lastname: Parker
authors.affiliation: Departments of Family Medicine and Epidemiology, Alpert Medical School of Brown University, Providence, Rhode Island (Parker, Eaton); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island (Parker, Eaton); Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts (Lu); University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, Pennsylvania (Sands-Lincoln); Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas (Brzyski, Schenken); Kaiser Permanente Division of Research, Oakland, California (Kroenke); Division of Geriatric Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (Lee); University of Miami, Miller School of Medicine, Department of Obstetrics/Gynecology, Miami, Florida (O'Sullivan); UC Irvine School of Medicine, Department of Epidemiology, Irvine, California (Park); John A. Burns School of Medicine (JABSOM), University of Hawaii, Honolulu, Hawaii (Parikh).
authors.forename: Bing
authors.initials: B
authors.lastname: Lu
authors.affiliation: Departments of Family Medicine and Epidemiology, Alpert Medical School of Brown University, Providence, Rhode Island (Parker, Eaton); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island (Parker, Eaton); Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts (Lu); University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, Pennsylvania (Sands-Lincoln); Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas (Brzyski, Schenken); Kaiser Permanente Division of Research, Oakland, California (Kroenke); Division of Geriatric Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (Lee); University of Miami, Miller School of Medicine, Department of Obstetrics/Gynecology, Miami, Florida (O'Sullivan); UC Irvine School of Medicine, Department of Epidemiology, Irvine, California (Park); John A. Burns School of Medicine (JABSOM), University of Hawaii, Honolulu, Hawaii (Parikh).
authors.forename: Megan
authors.initials: M
authors.lastname: Sands-Lincoln
authors.affiliation: Departments of Family Medicine and Epidemiology, Alpert Medical School of Brown University, Providence, Rhode Island (Parker, Eaton); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island (Parker, Eaton); Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts (Lu); University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, Pennsylvania (Sands-Lincoln); Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas (Brzyski, Schenken); Kaiser Permanente Division of Research, Oakland, California (Kroenke); Division of Geriatric Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (Lee); University of Miami, Miller School of Medicine, Department of Obstetrics/Gynecology, Miami, Florida (O'Sullivan); UC Irvine School of Medicine, Department of Epidemiology, Irvine, California (Park); John A. Burns School of Medicine (JABSOM), University of Hawaii, Honolulu, Hawaii (Parikh).
authors.forename: Candyce H
authors.initials: CH
authors.lastname: Kroenke
authors.affiliation: Departments of Family Medicine and Epidemiology, Alpert Medical School of Brown University, Providence, Rhode Island (Parker, Eaton); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island (Parker, Eaton); Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts (Lu); University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, Pennsylvania (Sands-Lincoln); Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas (Brzyski, Schenken); Kaiser Permanente Division of Research, Oakland, California (Kroenke); Division of Geriatric Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (Lee); University of Miami, Miller School of Medicine, Department of Obstetrics/Gynecology, Miami, Florida (O'Sullivan); UC Irvine School of Medicine, Department of Epidemiology, Irvine, California (Park); John A. Burns School of Medicine (JABSOM), University of Hawaii, Honolulu, Hawaii (Parikh).
authors.forename: Cathy C
authors.initials: CC
authors.lastname: Lee
authors.affiliation: Departments of Family Medicine and Epidemiology, Alpert Medical School of Brown University, Providence, Rhode Island (Parker, Eaton); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island (Parker, Eaton); Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts (Lu); University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, Pennsylvania (Sands-Lincoln); Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas (Brzyski, Schenken); Kaiser Permanente Division of Research, Oakland, California (Kroenke); Division of Geriatric Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (Lee); University of Miami, Miller School of Medicine, Department of Obstetrics/Gynecology, Miami, Florida (O'Sullivan); UC Irvine School of Medicine, Department of Epidemiology, Irvine, California (Park); John A. Burns School of Medicine (JABSOM), University of Hawaii, Honolulu, Hawaii (Parikh).
authors.forename: Mary
authors.initials: M
authors.lastname: O'Sullivan
authors.affiliation: Departments of Family Medicine and Epidemiology, Alpert Medical School of Brown University, Providence, Rhode Island (Parker, Eaton); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island (Parker, Eaton); Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts (Lu); University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, Pennsylvania (Sands-Lincoln); Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas (Brzyski, Schenken); Kaiser Permanente Division of Research, Oakland, California (Kroenke); Division of Geriatric Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (Lee); University of Miami, Miller School of Medicine, Department of Obstetrics/Gynecology, Miami, Florida (O'Sullivan); UC Irvine School of Medicine, Department of Epidemiology, Irvine, California (Park); John A. Burns School of Medicine (JABSOM), University of Hawaii, Honolulu, Hawaii (Parikh).
authors.forename: Hannah L
authors.initials: HL
authors.lastname: Park
authors.affiliation: Departments of Family Medicine and Epidemiology, Alpert Medical School of Brown University, Providence, Rhode Island (Parker, Eaton); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island (Parker, Eaton); Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts (Lu); University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, Pennsylvania (Sands-Lincoln); Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas (Brzyski, Schenken); Kaiser Permanente Division of Research, Oakland, California (Kroenke); Division of Geriatric Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (Lee); University of Miami, Miller School of Medicine, Department of Obstetrics/Gynecology, Miami, Florida (O'Sullivan); UC Irvine School of Medicine, Department of Epidemiology, Irvine, California (Park); John A. Burns School of Medicine (JABSOM), University of Hawaii, Honolulu, Hawaii (Parikh).
authors.forename: Nisha
authors.initials: N
authors.lastname: Parikh
authors.affiliation: Departments of Family Medicine and Epidemiology, Alpert Medical School of Brown University, Providence, Rhode Island (Parker, Eaton); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island (Parker, Eaton); Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts (Lu); University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, Pennsylvania (Sands-Lincoln); Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas (Brzyski, Schenken); Kaiser Permanente Division of Research, Oakland, California (Kroenke); Division of Geriatric Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (Lee); University of Miami, Miller School of Medicine, Department of Obstetrics/Gynecology, Miami, Florida (O'Sullivan); UC Irvine School of Medicine, Department of Epidemiology, Irvine, California (Park); John A. Burns School of Medicine (JABSOM), University of Hawaii, Honolulu, Hawaii (Parikh).
authors.forename: Robert S
authors.initials: RS
authors.lastname: Schenken
authors.affiliation: Departments of Family Medicine and Epidemiology, Alpert Medical School of Brown University, Providence, Rhode Island (Parker, Eaton); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island (Parker, Eaton); Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts (Lu); University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, Pennsylvania (Sands-Lincoln); Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas (Brzyski, Schenken); Kaiser Permanente Division of Research, Oakland, California (Kroenke); Division of Geriatric Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (Lee); University of Miami, Miller School of Medicine, Department of Obstetrics/Gynecology, Miami, Florida (O'Sullivan); UC Irvine School of Medicine, Department of Epidemiology, Irvine, California (Park); John A. Burns School of Medicine (JABSOM), University of Hawaii, Honolulu, Hawaii (Parikh).
authors.forename: Charles B
authors.initials: CB
authors.lastname: Eaton
mesh_terms: D000022:Abortion, Spontaneous; D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology*; D003327:Coronary Disease / Q000209:etiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D016017:Odds Ratio; D017698:Postmenopause; D011247:Pregnancy; D011446:Prospective Studies; D012306:Risk; D012307:Risk Factors; D050497:Stillbirth; D020521:Stroke / Q000209:etiology; D016387:Women's Health
keywords: cardiovascular diseases; coronary disease; miscarriage; stillbirth; women’s health