Elevated cardiovascular disease risk in low-income women with a history of pregnancy loss

OBJECTIVE: Pregnancy is associated with elevated risk of cardiovascular diseases (CVD), but little is known regarding the association between CVD and specific types of pregnancy losses. The aim of this study is to investigate the effects of pregnancy loss on the risk of subsequent CVD of any type. METHODS: This prospective longitudinal study examines medical records between 1999 and 2014 for Medicaid beneficiaries born after 1982 who lived in a state that funds all reproductive health services, including induced abortion. Unique pregnancy outcomes, history of diabetes, hyperlipidaemia or CVD (International Classification of Diseases, Ninth Revision (ICD-9): 401–459) prior to their first pregnancy outcome for each woman. Cumulative incidence rates of a first CVD diagnosis following a first pregnancy were calculated for the observed period, exceeding 12 years. RESULTS: A history of pregnancy loss was associated with 38% (OR=1.38; 95% CI=1.37 to 1.40) higher risk of a CVD diagnosis in the period observed. After controlling for history of diabetes, hyperlipidaemia, age, year of first pregnancy, race, state of residence, months of eligibility, number of pregnancies, births, number of losses before and after the first live birth, exposure to any pregnancy loss was associated with an 18% (adjusted OR=1.18; 95% CI=1.15 to 1.21) increased risk of CVD. Our analyses also reveal an important temporal relationship between the CVD and pregnancy loss. Immediate and short-term increased CVD risk is more characteristic for women whose first pregnancy ended in live birth while a delayed and more prolonged increased risk of CVD is associated with a first pregnancy loss. CONCLUSIONS: Our findings corroborate previous research showing that pregnancy loss is an independent risk factor for CVD, especially for diseases more chronic in nature. Our research contributes to understanding the specific needs for cardiovascular health monitoring for pregnant women and developing a consistent, evidence-based screening tools for both short-term and long-term follow-up.