Is stillbirth associated with long-term atherosclerotic morbidity?

Abstract

The purpose of this study was to investigate whether women who experienced at least 1 stillbirth are at increased risk for subsequent maternal long-term atherosclerotic morbidity. We conducted a population-based study that compared the incidence of long-term atherosclerotic morbidity in a cohort of women with and without previous stillbirth. Deliveries occurred during a 25-year period. Patients with known cardiovascular or renal disease before the index pregnancy were excluded from the study. Kaplan-Meier survival curves were used to estimate the cumulative incidence of cardiovascular- and renal-related hospitalizations. Cox proportional hazards models were used to estimate the adjusted hazards ratio for cardiovascular- and renal-related hospitalizations. Of 99,280 deliveries that met the inclusion criteria, 1879 deliveries (1.9%) occurred in patients who had had at least 1 stillbirth. After stillbirth, patients had a significantly higher cumulative incidence of cardiovascular and renal morbidity (Kaplan-Meier survival curve). During the follow-up period, patients with at least 1 stillbirth had higher rates of total cardiovascular and renal hospitalizations and had higher rates of simple and complex cardiovascular events. A significant stepwise increase was found between the number of stillbirths and future risk for cardiovascular morbidity. In a Cox proportional hazards model that was adjusted for confounders, previous stillbirth was associated independently with atherosclerotic morbidity. Stillbirth is an independent risk factor for long-term maternal atherosclerotic morbidity. The risk is higher for patients with recurrent episodes of stillbirth.