Pregnancy complications such as miscarriage, pre-eclampsia, gestational diabetes and pre-term birth are linked to a heightened risk of heart disease in later life, suggests an umbrella analysis published by the BMJ.
Previous research has suggested that risk factors specific to women may be linked to cardiovascular disease (CVD) and stroke, but clarity is needed on the quality of the evidence and on how the findings can be translated into public health and clinical practice.
A research team led by the University of Birmingham searched relevant databases for published systematic reviews and meta-analyses that investigated links between reproductive factors in women of reproductive age and subsequent risk of cardiovascular disease.
A total of 32 reviews were included, evaluating multiple risk factors over an average follow-up period of seven to 10 years.
The study found that several factors including early menarche, use of combined oral contraceptives, polycystic ovary syndrome, miscarriage, stillbirth, pre-eclampsia, diabetes during pregnancy, preterm birth, low birth weight and early menopause were associated with an up to twofold increased risk of CVD. Pre-eclampsia was associated with a fourfold increased risk of heart failure.
The authors said possible explanations for these associations include family medical history, genetics, weight, high blood pressure and cholesterol levels and chemical imbalances from use of hormonal contraceptives.
However, no association was found between CVD outcomes and current use of progesterone-only contraceptives, use of non-oral hormonal contraceptive agents or fertility treatment.
Breastfeeding was associated with a lower risk of CVD.
The researchers point to some limitations such as missing data and the fact that reviews were largely based on observational evidence, therefore, they cannot rule out the possibility that unmeasured confounding factors may have had an effect.
Nevertheless, they say the evidence suggests that from menarche to menopause, the reproductive profile of women is associated with their future risk of CVD.
