Journal
BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY
Volume 126, Issue 1, Pages 33-42Publisher
WILEY
DOI: 10.1111/1471-0528.15452
Keywords
Cardiovascular diseases; diabetes mellitus; hypercholesterolemia; hypertension; pregnancy loss; risk factors; spontaneous abortion; stillbirth; women's health
Categories
Funding
- Research Council of Norway [231149/F20]
- Ruth L. Kirschstein National Research Service Award [NHLBI F31 HL131222]
- National Heart, Lung, and Blood Institute [T32HL098048]
- American Heart Association [16PRE29690006]
- National Institutes of Health [UM1CA176726]
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Objective To assess the association between the outcome of a woman's first pregnancy and risk of clinical cardiovascular disease risk factors. Design Prospective cohort study. Setting and population Nurses' Health Study II. Methods Multivariable-adjusted Cox proportional hazards models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between first pregnancy outcome and hypertension, type 2 diabetes, and hypercholesterolemia. Main outcome measures Hypertension, type 2 diabetes, and hypercholesterolemia. Results Compared to women who reported a singleton live first birth, women with early spontaneous abortion (<12 weeks) had a greater rate of type 2 diabetes (HR: 1.20; 95% CI: 1.07-1.34) and hypercholesterolemia (HR: 1.06; 95% CI: 1.02-1.10), and a marginally increased rate of hypertension (HR: 1.05, 95% CI: 1.00-1.11). Late spontaneous abortion (12-19 weeks) was associated with an increased rate of type 2 diabetes (HR: 1.38; 95% CI: 1.14-1.65), hypercholesterolemia (HR: 1.11; 95% CI: 1.03-1.19), and hypertension (HR: 1.15; 95% CI: 1.05-1.25). The rates of type 2 diabetes (HR: 1.45; 95% CI: 1.13-1.87) and hypertension (HR: 1.15; 95% CI: 1.01-1.30) were higher in women who delivered stillbirth. In contrast, women whose first pregnancy ended in an induced abortion had lower rates of hypertension (HR: 0.87; 95% CI: 0.84-0.91) and type 2 diabetes (HR: 0.89; 95% CI: 0.79-0.99) than women with a singleton live birth. Conclusions Several types of pregnancy loss were associated with an increased rate of hypertension, type 2 diabetes, and hypercholesterolemia, which may provide novel insight into the pathways through which pregnancy outcomes and CVD are linked.
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