title: Is stillbirth associated with long-term atherosclerotic morbidity?
abstract: OBJECTIVE
  The purpose of this study was to investigate whether women who experienced at least 1 stillbirth are at increased risk for subsequent maternal long-term atherosclerotic morbidity.
  
  
  METHODS
  We conducted a population-based study that compared the incidence of long-term atherosclerotic morbidity in a cohort of women with and without previous stillbirth. Deliveries occurred during a 25-year period. Patients with known cardiovascular or renal disease before the index pregnancy were excluded from the study. Kaplan-Meier survival curves were used to estimate the cumulative incidence of cardiovascular- and renal-related hospitalizations. Cox proportional hazards models were used to estimate the adjusted hazards ratio for cardiovascular- and renal-related hospitalizations.
  
  
  RESULTS
  Of 99,280 deliveries that met the inclusion criteria, 1879 deliveries (1.9%) occurred in patients who had had at least 1 stillbirth. After stillbirth, patients had a significantly higher cumulative incidence of cardiovascular and renal morbidity (Kaplan-Meier survival curve). During the follow-up period, patients with at least 1 stillbirth had higher rates of total cardiovascular and renal hospitalizations and had higher rates of simple and complex cardiovascular events. A significant stepwise increase was found between the number of stillbirths and future risk for cardiovascular morbidity. In a Cox proportional hazards model that was adjusted for confounders, previous stillbirth was associated independently with atherosclerotic morbidity.
  
  
  CONCLUSIONS
  Stillbirth is an independent risk factor for long-term maternal atherosclerotic morbidity. The risk is higher for patients with recurrent episodes of stillbirth.
authors: Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel. Electronic address: galipa@bgu.ac.il.
authors: Gali
authors: G
authors: Pariente
authors: Department of Epidemiology and Health Services Evaluation, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors: Ilana
authors: I
authors: Shoham-Vardi
authors: Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors: Roy
authors: R
authors: Kessous
authors: Department of Epidemiology and Health Services Evaluation, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors: Ruslan
authors: R
authors: Sergienko
authors: Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors: Eyal
authors: E
authors: Sheiner
mesh_terms: D000328:Adult; D050197:Atherosclerosis / Q000453:epidemiology / Q000209:etiology*; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D011247:Pregnancy; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D050497:Stillbirth
keywords: atherosclerosis; long-term; maternal; morbidity; stillbirth