Pregnancy, pregnancy loss, and the risk of cardiovascular disease in Chinese women: Findings from the China Kadoorie Biobank

China Kadoorie Biobank (CKB) collaborative group

doi:10.1186/s12916-017-0912-7

Pregnancy, pregnancy loss, and the risk of cardiovascular disease in Chinese women: Findings from the China Kadoorie Biobank

China Kadoorie Biobank (CKB) collaborative group

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Abstract

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 language	English
Article number	148
Journal	BMC Medicine
Volume	15
Issue number	1
DOIs	https://doi.org/10.1186/s12916-017-0912-7
Publication status	Published - 8 Aug 2017
Externally published	Yes

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.

Funder

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).

Keywords

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

ASJC Scopus subject areas

Medicine(all)

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1186/s12916-017-0912-7Licence: CC0

PublishedFinal published version, 921 KBLicence: CC0

Cite this

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title = "Pregnancy, pregnancy loss, and the risk of cardiovascular disease in Chinese women: Findings from the China Kadoorie Biobank",

abstract = "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.",

keywords = "China Kadoorie Biobank (CKB), Recurrent Pregnancy Loss, Chinese Women, Induced Abortion, Circulatory Diseases",

author = "{China Kadoorie Biobank (CKB) collaborative group} and Peters, {Sanne A.E.} and Ling Yang and Yu Guo and Yiping Chen and Zheng Bian and Xiaocao Tian and Liang Chang and Shuo Zhang and Jiaqiu Liu and Tao Wang and Junshi Chen and Liming Li and Mark Woodward and Zhengming Chen and Rory Collins and Richard Peto and Daniel Avery and Derrick Bennett and Yumei Chang and Yiping Chen and Zhengming Chen and Robert Clarke and Huaidong Du and Xuejuan Fan and Simon Gilbert and Alex Hacker and Michael Holmes and Andri Iona and Christiana Kartsonaki and Rene Kerosi and Ling Kong and Om Kurmi and Garry Lancaster and Sarah Lewington and John McDonnell and Winnie Mei and Iona Millwood and Qunhua Nie and Jayakrishnan Radhakrishnan and Sajjad Rafiq and Paul Ryder and Sam Sansome and Dan Schmidt and Paul Sherliker and Rajani Sohoni and Iain Turnbull and Robin Walters and Jenny Wang and Lin Wang and Xiaoming Yang",

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. ",

year = "2017",

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doi = "10.1186/s12916-017-0912-7",

language = "English",

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TY - JOUR

T1 - Pregnancy, pregnancy loss, and the risk of cardiovascular disease in Chinese women

T2 - Findings from the China Kadoorie Biobank

AU - China Kadoorie Biobank (CKB) collaborative group

AU - Peters, Sanne A.E.

AU - Yang, Ling

AU - Guo, Yu

AU - Chen, Yiping

AU - Bian, Zheng

AU - Tian, Xiaocao

AU - Chang, Liang

AU - Zhang, Shuo

AU - Liu, Jiaqiu

AU - Wang, Tao

AU - Chen, Junshi

AU - Li, Liming

AU - Woodward, Mark

AU - Chen, Zhengming

AU - Collins, Rory

AU - Peto, Richard

AU - Avery, Daniel

AU - Bennett, Derrick

AU - Chang, Yumei

AU - Chen, Yiping

AU - Chen, Zhengming

AU - Clarke, Robert

AU - Du, Huaidong

AU - Fan, Xuejuan

AU - Gilbert, Simon

AU - Hacker, Alex

AU - Holmes, Michael

AU - Iona, Andri

AU - Kartsonaki, Christiana

AU - Kerosi, Rene

AU - Kong, Ling

AU - Kurmi, Om

AU - Lancaster, Garry

AU - Lewington, Sarah

AU - McDonnell, John

AU - Mei, Winnie

AU - Millwood, Iona

AU - Nie, Qunhua

AU - Radhakrishnan, Jayakrishnan

AU - Rafiq, Sajjad

AU - Ryder, Paul

AU - Sansome, Sam

AU - Schmidt, Dan

AU - Sherliker, Paul

AU - Sohoni, Rajani

AU - Turnbull, Iain

AU - Walters, Robin

AU - Wang, Jenny

AU - Wang, Lin

AU - Yang, Xiaoming

N1 - 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.

PY - 2017/8/8

Y1 - 2017/8/8

N2 - 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.

AB - 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.

KW - China Kadoorie Biobank (CKB)

KW - Recurrent Pregnancy Loss

KW - Chinese Women

KW - Induced Abortion

KW - Circulatory Diseases

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DO - 10.1186/s12916-017-0912-7

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C2 - 28784170

AN - SCOPUS:85027183649

SN - 1464-2662

VL - 15

JO - BMC Medicine

JF - BMC Medicine

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ER -

Pregnancy, pregnancy loss, and the risk of cardiovascular disease in Chinese women: Findings from the China Kadoorie Biobank

Abstract

Bibliographical note

Funder

Keywords

ASJC Scopus subject areas

UN SDGs

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