Background: Pregnancy 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. Methods: In 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. Results: Overall, 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. Conclusions: Among 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.

Original languageEnglish
Article number148
JournalBMC Medicine
Issue number1
Publication statusPublished - 8 Aug 2017
Externally publishedYes

Bibliographical note

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.


The baseline survey was funded by the Kadoorie Charitable Foundation, Hong Kong. Long-term continuation was funded by the UK Wellcome Trust (088158/ Z/09/Z, 104085/Z/14/Z), the Chinese Ministry of Science and Technology (2011BAI09B01, 2012-14), and the Chinese National Natural Science Foundation (81390541). The British Heart Foundation, UK Medical Research Council, and Cancer Research UK provide core funding to the Oxford Clinical Trial Service Unit. This work was also supported by grants from the National Natural Science Foundation of China (No. 81390541, No. 81390544).

Publisher Copyright:
© 2017 The Author(s).


  • China Kadoorie Biobank (CKB)
  • Recurrent Pregnancy Loss
  • Chinese Women
  • Induced Abortion
  • Circulatory Diseases

ASJC Scopus subject areas

  • Medicine(all)


Dive into the research topics of 'Pregnancy, pregnancy loss, and the risk of cardiovascular disease in Chinese women: Findings from the China Kadoorie Biobank'. Together they form a unique fingerprint.

Cite this