BackgroundPrevious studies have demonstrated an increased risk of cardiovascular disease (CVD) in women with a history of pregnancy loss. Less is known about whether pregnancy loss is associated with age at the onset of CVD, but this is a question of interest, as a demonstrated association of pregnancy loss with early-onset CVD may provide clues to the biological basis of the association, as well as having implications for clinical care. We conducted an age-stratified analysis of pregnancy loss history and incident CVD in a large cohort of postmenopausal women aged 50–79 years old.MethodsAssociations between a history of pregnancy loss and incident CVD were examined among participants in the Women's Health Initiative Observational Study. Exposures were any history of pregnancy loss (miscarriage and/or stillbirth), recurrent (2+) loss, and a history of stillbirth. Logistic regression analyses were used to examine associations between pregnancy loss and incident CVD within 5 years of study entry in three age strata (50–59, 69–69, and 70–79). Outcomes of interest were total CVD, coronary heart disease (CHD), congestive heart failure, and stroke. To assess the risk of early onset CVD, Cox proportional hazard regression was used to examine incident CVD before the age of 60 in a subset of subjects aged 50–59 at study entry.ResultsAfter adjustment for cardiovascular risk factors, a history of stillbirth was associated with an elevated risk of all cardiovascular outcomes in the study cohort within 5 years of study entry. Interactions between age and pregnancy loss exposures were not significant for any cardiovascular outcome; however, age-stratified analyses demonstrated an association between a history of stillbirth and risk of incident CVD within 5 years in all age groups, with the highest point estimate seen in women aged 50–59 (OR 1.99; 95% CI, 1.16–3.43). Additionally, stillbirth was associated with incident CHD among women aged 50–59 (OR 3.12; 95% CI, 1.33–7.29) and 60–69 (OR 2.06; 95% CI, 1.24–3.43) and with incident heart failure and stroke among women aged 70–79. Among women aged 50–59 with a history of stillbirth, a non-significantly elevated hazard ratio was observed for heart failure before the age of 60 (HR 2.93, 95% CI, 0.96–6.64).ConclusionsHistory of stillbirth was strongly associated with a risk of cardiovascular outcomes within 5 years of baseline in a cohort of postmenopausal women aged 50–79. History of pregnancy loss, and of stillbirth in particular, might be a clinically useful marker of cardiovascular disease risk in women.

Using lifetime data from two waves of the National Epidemiologic Surveys on Alcohol and Related Conditions, this study sought to examine sex- and race-specific risks in the temporal relationship between adult onset severe physical intimate partner violence (IPV) victimization and alcohol misuse (binge drinking) and alcohol use disorders (abuse and dependence) and whether or not childhood trauma moderated these relationships among U.S. non-Hispanic White and Black women and men. IPV predicted most alcohol outcomes among White and Black women and White men. Conversely, binge drinking among White and Black women and alcohol abuse among Black women and men predicted IPV. Childhood trauma moderated the relationship between IPV and alcohol misuse mainly among Black respondents, with an increased risk of either outcome among those without childhood trauma. These findings suggest a reciprocal relationship between IPV victimization and alcohol misuse, with implications for sex- and race-specific prevention and intervention efforts.