• PetersSanne A ESAEThe George Institute for Global Health, University of Oxford, Les Gros Clark Building, South Parks Road, Oxford, OX1 3QX, UK., Ling Yang, Yu Guo, Yiping Chen, Zheng Bian, Xiaocao Tian, Liang Chang, Shuo Zhang, Jiaqiu Liu, Tao Wang, Junshi Chen, Liming Li, Mark Woodward, Zhengming Chen, and China Kadoorie Biobank collaboration group.
• The George Institute for Global Health, University of Oxford, Les Gros Clark Building, South Parks Road, Oxford, OX1 3QX, UK.
• Bmc Med. 2017 Aug 8; 15 (1): 148148.

BackgroundPregnancy and pregnancy loss may be linked to cardiovascular disease (CVD). However, the evidence is still inconsistent, especially in East Asians, whose reproductive patterns differ importantly from those in the West. We examined the associations of pregnancy, miscarriage, induced abortion, and stillbirth with CVD incidence among Chinese women.MethodsIn 2004-2008, the nationwide China Kadoorie Biobank recruited 302,669 women aged 30-79 years from ten diverse localities. During 7 years of follow-up, 43,968 incident cases of circulatory disease, 14,440 of coronary heart disease, and 19,925 of stroke (including 11,430 ischaemic and 2170 haemorrhagic strokes), were recorded among 289,573 women without prior CVD at baseline. Cox regression yielded multiple adjusted hazard ratios (HRs) for CVD risks associated with pregnancy outcomes.ResultsOverall, 99% of women had been pregnant, and among them 10%, 53%, and 7% reported having a history of miscarriage, induced abortion, and stillbirth, respectively. Each additional pregnancy was associated with an adjusted HR of 1.03 (95% confidence interval, CI: 1.02; 1.04) for circulatory disease. A history of miscarriage, induced abortion, and stillbirth, respectively, were associated with adjusted HRs of 1.04 (1.01; 1.07), 1.04 (1.02; 1.07), and 1.07 (1.03; 1.11) for circulatory disease. The relationship was stronger with recurrent pregnancy loss; adjusted HRs for each additional loss being 1.04 (1.00; 1.09) for miscarriage, 1.02 (1.01; 1.04) for induced abortion, and 1.04 (1.00; 1.08) for stillbirth.ConclusionsAmong Chinese women, increases in pregnancy, and a history and recurrence of miscarriage, induced abortion, and stillbirth are each associated with a higher risk of CVD.

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