title: Relationship between recurrent miscarriage and early preterm delivery and recurrent events in patients with manifest vascular disease: The SMART study.
abstract: BACKGROUND
  Women with a complication of pregnancy are at increased risk of cardiovascular morbidity and mortality later in life. Yet, information on risk of recurrent events in women with a previous cardiovascular event is lacking. We aimed to assess the relationship between early preterm delivery, (recurrent) miscarriage and the risk for recurrent cardiovascular events in women with manifest vascular disease.
  
  
  METHODS
  We included 1014 women with a mean age of 60 years from the SMART study, a prospective ongoing cohort study among subjects with clinically manifest vascular disease. The included women had a history of ≥1 pregnancy and were followed for the occurrence of subsequent vascular events. The relationship between the pregnancy complications ((miscarriage (gestational age <14 weeks), recurrent miscarriage (≥3 miscarriages) and early preterm delivery (gestational age 14-32 weeks)) and cardiovascular morbidity and mortality were estimated using multivariable adjusted hazard ratios.
  
  
  RESULTS
  During a mean follow-up of 5.0 years, 80 women had a recurrent cardiovascular event, of which 28 were fatal. A history of recurrent miscarriage was associated with an increased risk for a recurrent cardiovascular event (hazard ratio 4.3 95% confidence interval 1.7--10.9). In addition, early preterm delivery was related to a 4.1 (95% confidence interval 1.5--11.3) fold increased risk of cardiovascular death in women with previous cardiovascular disease. No statistically significant relationships were found for less than three miscarriages.
  
  
  CONCLUSIONS
  In women with previous cardiovascular disease, an obstetric history of recurrent miscarriage is associated with an increased risk of recurrent cardiovascular morbidity and early preterm delivery with cardiovascular mortality.
authors.affiliation: Division of Woman and Baby, University Medical Center Utrecht, The Netherlands Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands k.y.heida@umcutrecht.nl.
authors.forename: Karst Y
authors.initials: KY
authors.lastname: Heida
authors.affiliation: Division of Woman and Baby, University Medical Center Utrecht, The Netherlands.
authors.forename: Maria Ph
authors.initials: MP
authors.lastname: Koster
authors.affiliation: Division of Woman and Baby, University Medical Center Utrecht, The Netherlands.
authors.forename: Arie
authors.initials: A
authors.lastname: Franx
authors.affiliation: Division of Woman and Baby, University Medical Center Utrecht, The Netherlands.
authors.forename: Jan Hw
authors.initials: JH
authors.lastname: Veerbeek
authors.affiliation: Department of Vascular Medicine, University Medical Center Utrecht, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Westerink
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
authors.forename: Michiel L
authors.initials: ML
authors.lastname: Bots
authors.affiliation: Department of Vascular Medicine, University Medical Center Utrecht, The Netherlands.
authors.forename: Wilko
authors.initials: W
authors.lastname: Spiering
mesh_terms: D000026:Abortion, Habitual / Q000453:epidemiology*; D000368:Aged; D005260:Female; D005865:Gestational Age; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D014652:Vascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality
keywords: Pregnancy; cardiovascular diseases; preterm birth; recurrent event; recurrent miscarriage