Classici Stranieri

by Florentia Vlachou, Despoina Iakovou, Jahnavi Daru, Rehan Khan, Litha Pepas, Siobhan Quenby, Stamatina Iliodromiti

Background

Evidence suggests common pathways between pregnancy losses and subsequent long-term maternal morbidity, rendering pregnancy complications an early chronic disease marker. There is a plethora of studies exploring associations between miscarriage and stillbirth with long-term adverse maternal health; however, these data are inconclusive.

Methods and findings

We systematically searched MEDLINE, EMBASE, AMED, BNI, CINAHL, and the Cochrane Library with relevant keywords and MeSH terms from inception to June 2023 (nolanguage restrictions). We included studies exploring associations between stillbirth or miscarriage and incidence of cardiovascular, malignancy, mental health, other morbidities, and all-cause mortality inwomen without previous pregnancy loss. Studies reporting short-term morbidity (within a year of loss), case reports, letters, andanimal studies were excluded. Study selection and data extraction were performed by 2 independent reviewers. Risk of bias was assessed using the Newcastle Ottawa Scale (NOS) and publication bias with funnel plots. Subgroup analysis explored the effect of recurrent losses on adverse outcomes. Statistical analysis was performed using an inverse variance random effects model and results are reported as risk ratios (RRs) with 95% confidence intervals (CIs) and prediction intervals (PIs) by combining the most adjusted RR, odds ratios (ORs) and hazard ratios (HRs) under the rare outcome assumption. We included 56 observational studies, including 45 in meta-analysis. There were 1,119,815 womenwho experienced pregnancy loss of whom 951,258 had a miscarriage and 168,557 stillbirth, compared with 11,965,574 women without previous loss. Womenwith a history of stillbirth had a greater risk of ischaemic heartdisease (IHD) RR 1.56, 95% CI [1.30, 1.88] ; p p p = 0.05, 95% PI [0.74, 4.10] ) comparedwithwomen without pregnancy loss. There was noevidence of increased risk of cardiovascular disease (IHD: RR 1.11, 95% CI [0.98, 1.27] , 95% PI [0.46, 2.76] or cerebrovascular: RR 1.01, 95% CI [0.85, 1.21] )inwomen experiencing a miscarriage. Only womenwitha previous stillbirth were more likely to develop type 2 diabetes mellitus (T2DM) (RR: 1.16, 95% CI [1.07 to 2.26] ; p p Conclusions

Our results suggest that womenwith a history of stillbirth have a greater risk of future cardiovascular disease, T2DM, and renal morbidities. Women experiencing miscarriages, single or multiple, do not seem to have an altered risk.