Does self-reported pregnancy loss identify women at risk of an adverse cardiovascular phenotype in later life? Insights from UK Biobank

Autoři: Einas Elmahi aff001;  Mihir M. Sanghvi aff002;  Alexander Jones aff003;  Christina Y. L. Aye aff001;  Adam J. Lewandowski aff001;  Nay Aung aff001;  Jackie A. Cooper aff001;  José Miguel Paiva aff001;  Elena Lukaschuk aff005;  Stefan K. Piechnik aff005;  Stefan Neubauer aff005;  Steffen E. Petersen aff002;  Paul Leeson aff001
Působiště autorů: Oxford Cardiovascular Clinical Research Facility, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe, Oxford, United Kingdom aff001;  William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, Queen Mary University of London, Charterhouse Square, London, Unite Kingdom, Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London, Unite aff002;  Department of Paediatrics, Children’s Hospital, John Radcliffe, University of Oxford, Oxford, United Kingdom aff003;  The Nuffield Department of Women's & Reproductive Health, Medical Science Division, University of Oxford, Oxford, United Kingdom aff004;  Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom aff005
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article



Cardiovascular disease (CVD) is more common in women who have had pregnancy complications such as spontaneous pregnancy loss. We used cross-sectional data from the UK Biobank Imaging Enhancement Study to determine whether pregnancy loss is associated with cardiac or vascular remodelling in later life, which might contribute to this increased risk.


Pregnancy history was reported by women participating in UK Biobank between 2006 and 2010 at age 40–69 years using a self-completed touch-screen questionnaire. Associations between self-reported spontaneous pregnancy loss and cardiovascular measures, collected in women who participated in the Imaging Enhancement Study up to the end of 2015, were examined. Cardiac structure and function were assessed by magnetic resonance (CMR) steady-state free precession imaging at 1.5 Tesla. Carotid intima-media thickness (CIMT) measurements were taken for both common carotid arteries using a CardioHealth Station. Statistical associations with CMR and carotid measures were adjusted for age, BMI and other cardiovascular risk factors.


Data were available on 2660 women of whom 111 were excluded because of pre-existing cardiovascular disease and 30 had no pregnancy information available. Of the remaining 2519, 446 were nulligravid and 2073 had a history of pregnancies, of whom 622 reported at least one pregnancy loss (92% miscarriages and 8% stillbirths) and 1451 reported no pregnancy loss. No significant differences in any cardiac or carotid parameters were evident in women who reported pregnancy loss compared to other groups (Table 1).


Women who self-report pregnancy loss do not have significant differences in cardiac structure, cardiac function, or carotid structure in later life to explain their increased cardiovascular risk. This suggests any cardiovascular risks associated with pregnancy loss operate through other disease mechanisms. Alternatively, other characteristics of pregnancy loss, which we were not able to take account of, such as timing and number of pregnancy losses may be required to identify those at greatest cardiovascular risk.

Klíčová slova:

Blood pressure – Cardiovascular diseases – Cardiovascular diseases in women – Hypertensive disorders in pregnancy – Medical risk factors – Pregnancy – Pregnancy complications


1. Wang X, Chen C, Wang L, Chen D, Guang W, French J. Conception, early pregnancy loss, and time to clinical pregnancy: a population-based prospective study. Fertility and Sterility. 2003;79(3):577–84. doi: 10.1016/s0015-0282(02)04694-0 12620443

2. Ford HB, Schust DJ. Recurrent pregnancy loss: etiology, diagnosis, and therapy. Reviews in obstetrics and gynecology. 2009;2(2):76. 19609401

3. Peters SA, Woodward M. Women’s reproductive factors and incident cardiovascular disease in the UK Biobank. Heart. 2018:heartjnl-2017-312289.

4. Oliver-Williams CT, Heydon EE, Smith GC, Wood AM. Miscarriage and future maternal cardiovascular disease: a systematic review and meta-analysis. Heart. 2013;99(22):1636–44. doi: 10.1136/heartjnl-2012-303237 23539554

5. Peters SA, Woodward M. Women’s reproductive factors and incident cardiovascular disease in the UK Biobank. Heart. 2018. doi: 10.1136/heartjnl-2017-312289 29335253

6. Kharazmi E, Dossus L, Rohrmann S, Kaaks R. Pregnancy loss and risk of cardiovascular disease: a prospective population-based cohort study (EPIC-Heidelberg). Heart. 2011;97(1):49–54. doi: 10.1136/hrt.2010.202226 21123827

7. Smith GC, Pell JP, Walsh D. Pregnancy complications and maternal risk of ischaemic heart disease: a retrospective cohort study of 129 290 births. The Lancet. 2001;357(9273):2002–6.

8. Gholizadeh L, Davidson P. More similarities than differences: an international comparison of CVD mortality and risk factors in women. Health care for women international. 2007;29(1):3–22.

9. Bluemke D, Mann D, Burke G, Lima J, Muntner P, Barr RG, et al. Association of Left Ventricular Hypertrophy With Incident Hypertension: The Multi-Ethnic Study of Atherosclerosis. American Journal of Epidemiology. 2011;173(8):898–905. doi: 10.1093/aje/kwq509 21422061

10. Sudlow C, Gallacher J, Allen N, Beral V, Burton P, Danesh J, et al. UK biobank: an open access resource for identifying the causes of a wide range of complex diseases of middle and old age. PLoS medicine. 2015;12(3):e1001779. doi: 10.1371/journal.pmed.1001779 25826379

11. Petersen SE, Matthews PM, Francis JM, Robson MD, Zemrak F, Boubertakh R, et al. UK Biobank's cardiovascular magnetic resonance protocol. Journal of cardiovascular magnetic resonance: official journal of the Society for Cardiovascular Magnetic Resonance. 2016;18:8. Epub 2016/02/03. doi: 10.1186/s12968-016-0227-4 26830817; PubMed Central PMCID: PMC4736703.

12. Coffey S, Lewandowski AJ, Garratt S, Meijer R, Lynum S, Bedi R, et al. Protocol and quality assurance for carotid imaging in 100,000 participants of UK Biobank: development and assessment. Eur J Prev Cardiol. 2017;24(17):1799–806. Epub 2017/09/20. doi: 10.1177/2047487317732273 28925747.

13. Smith GC, Wood AM, Pell JP, Hattie J. Recurrent miscarriage is associated with a family history of ischaemic heart disease: a retrospective cohort study. BJOG: an international journal of obstetrics and gynaecology. 2011;118(5):557–63. Epub 2011/01/20. doi: 10.1111/j.1471-0528.2010.02890.x 21244619.

14. Celik N, Evsen MS, Sak ME, Soydinc E, Gul T. Evaluation of the relationship between insulin resistance and recurrent pregnancy loss. Ginekologia polska. 2011;82(4):272–5. Epub 2011/07/05. 21721463.

15. Jungers P, Chauveau D, Choukroun G, Moynot A, Skhiri H, Houillier P, et al. Pregnancy in women with impaired renal function. Clinical nephrology. 1997;47(5):281–8. Epub 1997/05/01. 9181274.

16. Frick M, Weidinger F. Endothelial function: a surrogate endpoint in cardiovascular studies? Current pharmaceutical design. 2007;13(17):1741–50. Epub 2007/06/23. doi: 10.2174/138161207780831211 17584104.

17. Germain AM, Romanik MC, Guerra I, Solari S, Reyes MS, Johnson RJ, et al. Endothelial Dysfunction. Hypertension. 2007;49(1):90–5. doi: 10.1161/01.HYP.0000251522.18094.d4 17116761

18. Rodriguez CJ, Lin F, Sacco RL, Jin Z, Boden-Albala B, Homma S, et al. Prognostic Implications of Left Ventricular Mass Among Hispanics. The Northern Manhattan Study. 2006;48(1):87–92. doi: 10.1161/01.Hyp.0000223330.03088.58 16651457

19. Desai CS, Bartz TM, Gottdiener JS, Lloyd-Jones DM, Gardin JM. Usefulness of Left Ventricular Mass and Geometry for Determining 10-Year Prediction of Cardiovascular Disease in Adults > 65 Years of Age (From the Cardiovascular Health Study). The American journal of cardiology. 2016;118(5):684–90. doi: 10.1016/j.amjcard.2016.06.016 27457431; PubMed Central PMCID: PMC4988901.

20. Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Prognostic Implications of Echocardiographically Determined Left Ventricular Mass in the Framingham Heart Study. New England Journal of Medicine. 1990;322(22):1561–6. doi: 10.1056/NEJM199005313222203 2139921.

21. Bluemke DA, Kronmal RA, Lima JA, Liu K, Olson J, Burke GL, et al. The relationship of left ventricular mass and geometry to incident cardiovascular events: the MESA (Multi-Ethnic Study of Atherosclerosis) study. Journal of the American College of Cardiology. 2008;52(25):2148–55. doi: 10.1016/j.jacc.2008.09.014 19095132

22. Salerno M, Sharif B, Arheden H, Kumar A, Axel L, Li D, et al. Recent Advances in Cardiovascular Magnetic Resonance: Techniques and Applications. Circulation Cardiovascular imaging. 2017;10(6). Epub 2017/06/15. doi: 10.1161/circimaging.116.003951 28611116; PubMed Central PMCID: PMC5777859.

23. Jordan JH, Todd RM, Vasu S, Hundley WG. Cardiovascular Magnetic Resonance in the Oncology Patient. JACC Cardiovascular imaging. 2018;11(8):1150–72. Epub 2018/08/11. doi: 10.1016/j.jcmg.2018.06.004 30092971; PubMed Central PMCID: PMC6242266.

24. Wilcox AJ, Weinberg CR, O'Connor JF, Baird DD, Schlatterer JP, Canfield RE, et al. Incidence of early loss of pregnancy. The New England journal of medicine. 1988;319(4):189–94. Epub 1988/07/28. doi: 10.1056/NEJM198807283190401 3393170.

25. Wang X, Chen C, Wang L, Chen D, Guang W, French J. Conception, early pregnancy loss, and time to clinical pregnancy: a population-based prospective study. Fertil Steril. 2003;79(3):577–84. Epub 2003/03/07. doi: 10.1016/s0015-0282(02)04694-0 12620443.

26. Zinaman MJ, Clegg ED, Brown CC, O'Connor J, Selevan SG. Estimates of human fertility and pregnancy loss. Fertil Steril. 1996;65(3):503–9. Epub 1996/03/01. 8774277.

27. Lang K, Nuevo-Chiquero A. Trends in self-reported spontaneous abortions: 1970–2000. Demography. 2012;49(3):989–1009. doi: 10.1007/s13524-012-0113-0 22718315.

28. Ranthe MF, Boyd HA. Miscarriage and cardiovascular disease. Heart. 2015;101(24):1933–4. doi: 10.1136/heartjnl-2015-308383 26385454

29. Eikendal AL, Groenewegen KA, Anderson TJ, Britton AR, Engström G, Evans GW, et al. Common carotid intima-media thickness relates to cardiovascular events in adults aged< 45 years. Hypertension. 2015:HYPERTENSIONAHA. 114.04658.

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