Joint Association of Parity and Spontaneous Miscarriage with Incident Cardiovascular Diseases

Q: What are the key findings of this study?

Having >=4 live births and a history of spontaneous miscarriage was associated with the highest risk of CHD (HR 1.43, 95% CI 1.28-1.60) compared to 2 live births without miscarriage.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Cardiovascular diseases (CHD, stroke, PAD, HF, AF) (n=231109). Intervention: Four or more live births and a history of spontaneous miscarriage vs. Two live births and no history of spontaneous miscarriage. Primary outcome: Incident coronary heart disease (CHD) (HR 1.43, 95% CI 1.28-1.60).

Q: What does this research mean for the field?

Parity exhibits a positive linear association with coronary heart disease risk and U-shaped associations with heart failure and atrial fibrillation risks, patterns that are not modified by a history of spontaneous miscarriage. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Ying Hu; Jiajia Song; Hao Ma; Xuan Wang; Shuqi Zhu; Feng Ye; Danqing Chen; Zhaoxia Liang

doi:10.2147/ijwh.s642813

October 31, 2026International Journal of Women s HealthOpen Access

Joint Association of Parity and Spontaneous Miscarriage with Incident Cardiovascular Diseases

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Key result

History of >=4 births plus miscarriage is linked to ~43% higher CHD risk.

HR 1.43
95% CI 1.28-1.60
n=231,109

Why the study?

The study aimed to prospectively investigate the combined association of parity and spontaneous miscarriage in relation to incident cardiovascular disease risks.

Does parity and a history of spontaneous miscarriage, individually and in combination, increase the risk of incident cardiovascular diseases (CHD, stroke, PAD, HF, and AF) in ever-pregnant women?

Key Points

To evaluate the prospective joint association of parity and spontaneous miscarriage with the risk of incident cardiovascular diseases.
Prospective cohort study analyzing UK Biobank participants across outcome-specific cohorts: 219,422 free of baseline coronary heart disease (CHD) or stroke, and 230,231, 230,589, and 229,123 free of peripheral arterial disease (PAD), heart failure (HF), and atrial fibrillation (AF), respectively.
Multivariable Cox proportional hazards models adjusted for age, ethnicity, education level, and Townsend deprivation index were used over a median follow-up of 12.2 years.
The number of live births displayed a positive linear association with CHD risk (P < 0.001 for linearity), while nonlinear U-shaped associations occurred for HF and AF (both P < 0.001 for nonlinearity), with lowest risks at two live births.
History of spontaneous miscarriage did not modify parity associations; compared to two live births and no miscarriage, participants with zero live births and no miscarriage had lower CHD risk (HR = 0.81, 95% CI = 0.68–0.95), while those with four or more live births and a history of miscarriage had the highest risk (HR = 1.43, 95% CI = 1.28–1.60).
Participants with four or more live births and a history of spontaneous miscarriage also demonstrated the highest risk estimates for HF and AF.

Study Design

Type

Cohort (n=231,109)

Multicenter

Yes

Structured PICO

Does parity and a history of spontaneous miscarriage, individually and in combination, increase the risk of incident cardiovascular diseases (CHD, stroke, PAD, HF, and AF) in ever-pregnant women?

P

Population

231,109 ever-pregnant women aged 40-69 years from the UK Biobank (including 219,422 free of prevalent CHD or stroke), followed for a median of 12.2 years.

E

Exposure

Exposure to varying levels of parity (0, 1, 2, 3, and ≥4 live births) and history/number of spontaneous miscarriages (0, 1, 2, and ≥3), evaluated individually and as combined joint categories.

C

Comparator

Reference group of women with 2 live births (for parity analyses), 0 spontaneous miscarriages (for miscarriage analyses), and the combined category of 2 live births and no history of spontaneous miscarriage (for joint association analyses).

O

Outcome

Incident rates of five major components of cardiovascular diseases (coronary heart disease [CHD], stroke, peripheral arterial disease [PAD], heart failure [HF], and atrial fibrillation [AF]) defined by ICD-10 codes from linked hospital inpatient and death records over a median follow-up of 12.2 years.hard clinical

Main Result

Hazard Ratio: 1.43 (95% CI 1.28–1.6)

Limitations

Parity and spontaneous miscarriage were primarily self-reported at baseline
Parity was treated as fixed during follow-up and post-enrollment births were not captured
Observational design subject to potential residual confounding and overadjustment in mediator-adjusted models
Associations of three or more miscarriages with stroke, PAD, and HF attenuated toward the null in competing-risk models
Parity was ascertained at baseline only and treated as fixed during follow-up; post-enrollment births were not captured.
When competing mortality was accounted for using Fine–Gray models, the associations of three or more miscarriages with stroke, PAD, and HF attenuated toward the null and were no longer statistically significant.

Implication

This large prospective cohort study demonstrates that higher parity and history of spontaneous miscarriage are independently associated with elevated risks of CHD, stroke, PAD, HF, and AF, with women having four or more live births and prior miscarriage facing the highest cardiovascular risk.

Abstract

Background: To prospectively investigate the combined association of parity and spontaneous miscarriage in relation to cardiovascular diseases (CVD) risks. Methods: In this prospective UK Biobank cohort analysis, multivariable Cox proportional hazards models were used in outcome-specific analytic cohorts: 219,422 participants free of prevalent CHD or stroke (CHD and stroke analyses) and 230,231, 230,589, and 229,123 participants free of the respective prevalent condition (PAD, HF, and AF analyses). Results: During a median follow-up of 12.2 years, parity exhibited a significant positive linear association with CHD risk. Nonlinear U-shaped associations were observed with HF and AF risks, with two live births representing the lowest risk. Importantly, a history of spontaneous miscarriage did not modify these associations. Compared to participants with two live births and no history of spontaneous miscarriage, individuals without any live births and no history of spontaneous miscarriage had the lowest point estimate for CHD (hazard ratio [HR] = 0.81, 95% confidence interval [CI] = 0.68– 0.95), whereas those with four or more live births and a history of spontaneous miscarriage exhibited the highest point estimate (HR = 1.43, 95% CI = 1.28– 1.60). Participants with four or more live births and a history of spontaneous miscarriage had the highest point estimate for HF and AF. Conclusion: The combined association of parity and spontaneous miscarriage and the risk for various CVDs exhibits outcome-specific patterns.

Discussion

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Cite This Study

Hu et al. (2026) conducted a cohort in Cardiovascular diseases (CHD, stroke, PAD, HF, AF) (n=231,109). Four or more live births and a history of spontaneous miscarriage vs. Two live births and no history of spontaneous miscarriage was evaluated on Incident coronary heart disease (CHD) (HR 1.43, 95% CI 1.28-1.60). Having >=4 live births and a history of spontaneous miscarriage was associated with the highest risk of CHD (HR 1.43, 95% CI 1.28-1.60) compared to 2 live births without miscarriage.

synapsesocial.com/papers/6ae7d421edffb496294104a1 https://doi.org/10.2147/ijwh.s642813

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Joint Association of Parity and Spontaneous Miscarriage with Incident Cardiovascular Diseases

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Joint Association of Parity and Spontaneous Miscarriage with Incident Cardiovascular Diseases

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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