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Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review.

ABSTRACT: OBJECTIVE:To consolidate evidence from systematic reviews and meta-analyses investigating the association between reproductive factors in women of reproductive age and their subsequent risk of cardiovascular disease. DESIGN:Umbrella review. DATA SOURCES:Medline, Embase, and Cochrane databases for systematic reviews and meta-analyses from inception until 31 August 2019. REVIEW METHODS:Two independent reviewers undertook screening, data extraction, and quality appraisal. The population was women of reproductive age. Exposures were fertility related factors and adverse pregnancy outcomes. Outcome was cardiovascular diseases in women, including ischaemic heart disease, heart failure, peripheral arterial disease, and stroke. RESULTS:32 reviews were included, evaluating multiple risk factors over an average follow-up period of 7-10 years. All except three reviews were of moderate quality. A narrative evidence synthesis with forest plots and tabular presentations was performed. Associations for composite cardiovascular disease were: twofold for pre-eclampsia, stillbirth, and preterm birth; 1.5-1.9-fold for gestational hypertension, placental abruption, gestational diabetes, and premature ovarian insufficiency; and less than 1.5-fold for early menarche, polycystic ovary syndrome, ever parity, and early menopause. A longer length of breastfeeding was associated with a reduced risk of cardiovascular disease. The associations for ischaemic heart disease were twofold or greater for pre-eclampsia, recurrent pre-eclampsia, gestational diabetes, and preterm birth; 1.5-1.9-fold for current use of combined oral contraceptives (oestrogen and progesterone), recurrent miscarriage, premature ovarian insufficiency, and early menopause; and less than 1.5-fold for miscarriage, polycystic ovary syndrome, and menopausal symptoms. For stroke outcomes, the associations were twofold or more for current use of any oral contraceptive (combined oral contraceptives or progesterone only pill), pre-eclampsia, and recurrent pre-eclampsia; 1.5-1.9-fold for current use of combined oral contraceptives, gestational diabetes, and preterm birth; and less than 1.5-fold for polycystic ovary syndrome. The association for heart failure was fourfold for pre-eclampsia. No association was found between cardiovascular disease outcomes and current use of progesterone only contraceptives, use of non-oral hormonal contraceptive agents, or fertility treatment. CONCLUSIONS:From menarche to menopause, reproductive factors were associated with cardiovascular disease in women. In this review, presenting absolute numbers on the scale of the problem was not feasible; however, if these associations are causal, they could account for a large proportion of unexplained risk of cardiovascular disease in women, and the risk might be modifiable. Identifying reproductive risk factors at an early stage in the life of women might facilitate the initiation of strategies to modify potential risks. Policy makers should consider incorporating reproductive risk factors as part of the assessment of cardiovascular risk in clinical guidelines. SYSTEMATIC REVIEW REGISTRATION:PROSPERO CRD42019120076.

SUBMITTER: Okoth K

PROVIDER: S-EPMC7537472 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review.

Okoth Kelvin K Chandan Joht Singh JS Marshall Tom T Thangaratinam Shakila S Thomas G Neil GN Nirantharakumar Krishnarajah K Adderley Nicola J NJ

BMJ (Clinical research ed.) 20201007

<h4>Objective</h4>To consolidate evidence from systematic reviews and meta-analyses investigating the association between reproductive factors in women of reproductive age and their subsequent risk of cardiovascular disease.<h4>Design</h4>Umbrella review.<h4>Data sources</h4>Medline, Embase, and Cochrane databases for systematic reviews and meta-analyses from inception until 31 August 2019.<h4>Review methods</h4>Two independent reviewers undertook screening, data extraction, and quality appraisa ...[more]

PMID: 33028606

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Project description:BACKGROUND:Previous studies have identified that women living in developed countries have insufficient knowledge of factors which may be contributing to the increasingly high global infertility rates such as maternal age and assisted reproductive technologies. There is a large market of reproductive health smartphone applications, yet little is known about the advantages these apps may confer to users in regards to reproductive health knowledge. METHODS:An anonymous, online survey of women living in Australia aged 18 and above was open March-June 2018, until ?200 responses were acquired for statistical power. Respondents answered questions regarding knowledge about general fertility and related factors (age, cyclic fertility, smoking, obesity, miscarriage rate, and success of assisted reproductive technologies). Fertility knowledge was compared in respondents who did or did not use apps relating to female reproductive health. Additionally the functions preferred in reproductive health apps was described by app using respondents. Sociodemographic information was also collected, and relevant data within the dataset was subject to multivariable modelling for the outcome of the fertility knowledge questions. RESULTS:Of the 673 respondents that completed the survey, 43.09% reported using mobile phone applications relating to female reproductive health. On average, respondents answered only three of the six fertility knowledge questions correctly. App using respondents were more likely to score better on one question, related to fertility during the menstrual cycle (p?<?0.001). App users most commonly reported using the menstrual tracking function in apps (82.4%), which may account for the increased knowledge of cyclic fertility. CONCLUSIONS:This data provides preliminary evidence toward the usefulness of smartphone applications as a medium for providing information about fertility to women. A limited understanding of one's own fertility was demonstrated despite being essential for the decision-making of women throughout their reproductive years.

Project description:IntroductionInadequate efforts towards meeting the sexual and reproductive health needs of adolescents and young people, who disproportionately share the burden of unwanted pregnancies, poor maternal and child health outcomes, risks of RTI/STI and HIV/AIDS, increase the risk of losing much of the progress made towards the Millennium Development Goals over the last decade, particularly in the context of low-and-middle-income countries like India.Data and methodsUsing the nationally representative data on 160551 unmarried young women aged 15-24 years from the District Level Reproductive and Child Health Survey (DLHS: 2007-2008) in India, this research evaluated the demographic and socioeconomic differentials in the access to family life/sex education (FLE) among youth in India. Using the adjusted multiple logistic regression models, the association between access to family life/sex education and attitudes towards a range of sexual and reproductive health matters among young unmarried Indian women were investigated.ResultsLess than half of the unmarried young women had received some form of FLE (48 percent) in India. However, there were substantial demographic and socioeconomic variations in their access to FLE, as relatively less educated women from the poorest wealth quintiles, religious and social minorities (Muslims, Scheduled Castes/Scheduled Tribes) were significantly less likely to receive FLE as compared to other women. Importantly, the likelihood of holding favourable/positive attitudes towards reproductive processes, knowledge and discussion of contraceptive methods, precise awareness about the transmission pathways of RTIs/STIs and HIV/AIDS was significantly higher among those women in India who had access to FLE.ConclusionThe present research underscores the protective role of family life education towards improving the sexual and reproductive life experiences of young people. It further underscores the vital need to implement a comprehensive and culturally appropriate programme of family life education in order to meet the sexual and reproductive health demands of the adolescents and young people in India.

Project description:ImportanceLittle is known regarding the association between level of blood pressure (BP) in young adulthood and cardiovascular disease (CVD) events by middle age.ObjectiveTo assess whether young adults who developed hypertension, defined by the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) BP guideline, before age 40 years have higher risk for CVD events compared with those who maintained normal BP.Design, setting, and participantsAnalyses were conducted in the prospective cohort Coronary Artery Risk Development in Young Adults (CARDIA) study, started in March 1985. CARDIA enrolled 5115 African American and white participants aged 18 to 30 years from 4 US field centers (Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota; and Oakland, California). Outcomes were available through August 2015.ExposuresUsing the highest BP measured from the first examination to the examination closest to, but not after, age 40 years, each participant was categorized as having normal BP (untreated systolic BP [SBP] <120 mm Hg and diastolic BP [DBP] <80 mm Hg; n = 2574); elevated BP (untreated SBP 120-129 mm Hg and DBP <80 mm Hg; n = 445); stage 1 hypertension (untreated SBP 130-139 mm Hg or DBP 80-89 mm Hg; n = 1194); or stage 2 hypertension (SBP ≥140 mm Hg, DBP ≥90 mm Hg, or taking antihypertensive medication; n = 638).Main outcomes and measuresCVD events: fatal and nonfatal coronary heart disease (CHD), heart failure, stroke, transient ischemic attack, or intervention for peripheral artery disease (PAD).ResultsThe final cohort included 4851 adults (mean age when follow-up for outcomes began, 35.7 years [SD, 3.6]; 2657 women [55%]; 2441 African American [50%]; 206 taking antihypertensive medication [4%]). Over a median follow-up of 18.8 years, 228 incident CVD events occurred (CHD, 109; stroke, 63; heart failure, 48; PAD, 8). CVD incidence rates for normal BP, elevated BP, stage 1 hypertension, and stage 2 hypertension were 1.37 (95% CI, 1.07-1.75), 2.74 (95% CI, 1.78-4.20), 3.15 (95% CI, 2.47-4.02), and 8.04 (95% CI, 6.45-10.03) per 1000 person-years, respectively. After multivariable adjustment, hazard ratios for CVD events for elevated BP, stage 1 hypertension, and stage 2 hypertension vs normal BP were 1.67 (95% CI, 1.01-2.77), 1.75 (95% CI, 1.22-2.53), and 3.49 (95% CI, 2.42-5.05), respectively.Conclusions and relevanceAmong young adults, those with elevated blood pressure, stage 1 hypertension, and stage 2 hypertension before age 40 years, as defined by the blood pressure classification in the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines, had significantly higher risk for subsequent cardiovascular disease events compared with those with normal blood pressure before age 40 years. The ACC/AHA blood pressure classification system may help identify young adults at higher risk for cardiovascular disease events.

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Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review.

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Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review.

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