Maternal cardiovascular and cerebrovascular health after placental abruption: a systematic review and meta-analysis (CHAP-SR)
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Placental abruption and cardiovascular disease (CVD) have common etiological underpinnings, and there is accumulating evidence that abruption may be associated with future CVD. We estimated associations between abruption and coronary heart disease (CHD) and stroke. The meta-analysis was based on the random-effects risk ratio (RR) and 95% confidence interval (CI) as the effect measure. We conducted a bias analysis to account for abruption misclassification, selection bias, and unmeasured confounding. We included 11 cohort studies comprising 6,325,152 pregnancies, 69,759 abruptions, and 49,265 CHD and stroke cases (1967-2016). Risks of combined CVD morbidity-mortality among abruption and nonabruption groups were 16.7 and 9.3 per 1,000 births, respectively (RR = 1.76, 95% CI: 1.24, 2.50; I2 = 94%; τ2 = 0.22). Women who suffered abruption were at 2.65-fold (95% CI: 1.55, 4.54; I2 = 85%; τ2 = 0.36) higher risk of death related to CHD/stroke than nonfatal CHD/stroke complications (RR = 1.32, 95% CI: 0.91, 1.92; I2 = 93%; τ2 = 0.15). Abruption was associated with higher mortality from CHD (RR = 2.64, 95% CI: 1.57, 4.44; I2 = 76%; τ2 = 0.31) than stroke (RR = 1.70, 95% CI: 1.19, 2.42; I2 = 40%; τ2 = 0.05). Corrections for the aforementioned biases increased these estimates. Women with pregnancies complicated by placental abruption may benefit from postpartum screening or therapeutic interventions to help mitigate CVD risks.
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A systematic review and meta-analysis of 11 studies comprising 6,325,152 pregnancies found that the risk of combined CVD and stroke mortality was 2.65-fold (95% CI 1.55-4.54) higher among pregnant people with abruption compared to those without abruption.
“A recent systematic review and meta-analysis of 11 studies comprising 6,325,152 pregnancies suggested that the risk of combined CVD and stroke mortality was 2.65-fold (95% CI 1.55–4.54) higher among pregnant people with abruption compared to those without abruption (111).”
From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [111]
In the same meta-analysis, the risk of non-fatal CVD and stroke complications was 1.32-fold (95% CI 0.91-1.92) higher among pregnant people with abruption compared to those without abruption.
“Similarly, the risk of non-fatal CVD and stroke complications was 1.32-fold (95% CI 0.91–1.92) higher among pregnant people with abruption compared to those without abruption.”
From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [111]
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Ananth, C. V., Lee, R., Valeri, L., Ross, Z., Graham, H. L., Khan, S. P., Cabrera, J., Rosen, T., & Kostis, W. J. (2024) · Paediatric and Perinatal Epidemiology · doi:10.1111/ppe.13039 · Cited by 6 · see citing works
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Mandujano, A., Lauria, M. R., & Waters, T. P. (2025) · Obstetrics and Gynecology Clinics of North America · doi:10.1016/j.ogc.2025.05.012 · Cited by 3 · see citing works
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Adverse pregnancy outcomes and long-term cardiovascular disease risk
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Current Resources for Evidence-Based Practice, March 2022
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Cardiovascular disease and mortality following placental abruption
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Cardiovascular Health in Women
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- Authors
- Ananth, C. V., Patrick, H. S., Ananth, S., Zhang, Y., Kostis, W. J., & Schuster, M.
- Affiliations
- Rutgers, The State University of New Jersey (US)
- New York University (US)
- Corresponding author
- Ananth, Cande V
- Venue
- American Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2021-07-14
- Volume
- 190
- Issue
- 12
- Pages
- 2718-2729
- ISSN
- 0002-9262 (ISSN-L)
- 1476-6256
- PMC
- PMC8796796
- OpenAlex
- W3182784010
- Cited by
- 35
- References
- 74
- Citations by year
- 2026: 10 · 2025: 8 · 2024: 7 · 2023: 5 · 2022: 3 · 2021: 2
- FWCI
- 0.78
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- American Journal of Epidemiology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Rutgers University Community Repository (Rutgers University) (submittedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01-HL150065)
- National Institute of Environmental Health Sciences (R01-ES033190)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
- Health Sciences › Medicine › Psychiatry and Mental health › Neurological Complications and Syndromes
- Keywords
- placental abruption, cardiovascular disease, coronary artery disease, stroke, maternal mortality, cerebrovascular disease, postpartum cardiovascular risk, pregnancy complications, misclassification bias, selection bias, unmeasured confounding
- MeSH terms
- Abruptio Placentae, Cardiovascular Diseases, Coronary Disease, Female, Humans, Pregnancy, Risk Factors, Stroke, Observational Studies as Topic
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