Large study shows miscarriage or stillbirth may increase stroke risk

New Research shows that women who have had a miscarriage or stillbirth have an increased risk of: heart attack – when blood cannot reach the brain due to a blocked or burst artery. That risk increases with each miscarriage or stillbirth.

It is difficult to make this connection because it must follow a large number of women over a long period of time and must have reliable data on women’s experiences. our studypublished by the British medical journal today (June 22), is the first to convincingly demonstrate the link between pregnancy loss and stroke.

Many women are not aware that their experiences during pregnancy can be an early marker of later health risks. Our findings show that their physicians should be alert to their increased risk.

It’s possible that infertility, miscarriage, and stillbirth can increase your risk of stroke because of other health conditions. These can include endocrine disorders (low estrogen or insulin resistance), inflammation, problems with endothelial cells that help with blood flow, mental disorders, unhealthy behaviors (such as smoking), or obesity.

Heartbreak and then risk of stroke

U.S Research is based on pooled data from 618,851 women who participated in eight separate studies in Australia, China, Japan, the Netherlands, Sweden, the United Kingdom, and the United States.

The women were aged between 32 and 73 when they first entered the studies and were followed for an average of 11 years.

The study found that over the time they were studied, 9,265 (2.8 percent) women had at least one nonfatal stroke and 4,003 (0.7 percent) women had a fatal stroke. A total of 91,569 (16.2 percent) women had a history of miscarriage, while 24,873 (4.6 percent) had a history of stillbirth.

Of the women who had ever been pregnant, women who reported a miscarriage had an 11 percent higher risk of a non-fatal stroke and 17 percent higher risk of a fatal stroke compared with women who had not miscarried.

The risk increased with each miscarriage, so women who had three or more miscarriages had a 35 percent higher risk of a nonfatal stroke (from an incidence of 43 per 100,000″person yearsto 58 per 100,000) and an 82 percent higher risk of fatal stroke (from 11.3 per 100,000 person-years to 18 per 100,000) compared with women who had never miscarried.

Stillbirth also significantly increased the risk of stroke.

Among women who had ever been pregnant, women with a history of stillbirth had a 31% higher risk of nonfatal stroke (from an incidence of 42 per 100,000 person-years to 69.5 per 100,000) and a 7 percent higher risk of a fatal stroke. ending. to succeed.

Again, the greater the number of stillbirths, the greater the risk of later strokes, with women who had two or more stillbirths having a 26 percent higher risk of fatal strokes (rising from 11 per 100,000 person-years to 51.1 per 100,000).

The study is the first to show links with stroke subtypes: Stillbirths were associated with nonfatal ischemic (blocking) stroke or fatal hemorrhagic (bleeding) stroke; miscarriages were linked to both subtypes.

Our study reinforces the findings of a previous systematic review who found similar results but showed limited evidence associated with stroke subtypes.

Of the possible explanations for these links, issues with endothelial cells (which control vascular relaxation and contraction and release blood-clotting enzymes) can lead to pregnancy loss due to problems with the placenta. These problems are also related to how blood vessels dilate and become inflamed or blocked during a stroke

Adjust for known risk factors

Our findings adjusted for many of the known stroke risk factors: body mass index, whether the women smoked or not, whether they had high blood pressure, or diabetes mellitus† The numbers have also been adjusted for ethnicity and education level.

By adjusting for risk factors, we can isolate the increased risk likely related to the number of miscarriages or stillbirths in the women.

What should women and their doctors do with this information?

When doctors have a heart health checkthey look at the risk of cardiovascular disease general – ie heart disease, heart failure and stroke. By considering these risks, doctors assess and predict the risk of future diseases.

The current Australian guidelines recommends regular heart health checks for people ages 45 to 74, or for Aboriginal and Torres Strait Islander peoples over the age of 30 — this is when the risk of cardiovascular disease begins to increase.

The guidelines recommend medication (blood pressure medication and/or lipid-lowering medication such as statins) if the risk of cardiovascular disease is greater than 15 percent in the next five years.

These guidelines are currently being updated by the Australian Alliance for Chronic Disease Prevention (including the Cancer Council Australia, Diabetes Australia, Kidney Health Australia, National Heart Foundation of Australia and the Stroke Foundation), but more recent international guidelines recommend lower-risk medications.

Whatever your risk of cardiovascular disease, the best way to prevent stroke is to lead the healthiest lifestyle possible: quit smoking, eat a healthy diet, moderate alcohol consumption, and get regular exercise.

These lifestyle measures lower the risk for everyone, but doctors will do their best to help people who are at long-term risk.

Our research shows that miscarriage and stillbirth are signs that a woman has an increased risk of cardiovascular disease. These events occur many years before a woman develops other risk factors, such as high blood pressure, diabetes, or high cholesterol.

Women who have had a miscarriage or stillbirth should discuss this with their doctor. Knowing you have a higher risk of stroke is an opportunity to monitor your health and make lifestyle changes that can help prevent stroke.

GPs should ask about women’s reproductive histories and be aware of recurrent miscarriages and stillbirths as possible predictors of stroke risk.

Gita MishraProfessor of Life Course Epidemiology, Faculty of Medicine, The University of QueenslandChen LiangPhD student, The University of Queenslandand Jenny DoustClinical Professorial Research Fellow, The University of Queensland

This article was republished from The conversation under a Creative Commons license. Read the original article

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