MATERNAL CARDIOVASCULAR AND CEREBROVASCULAR HEALTH AFTER PLACENTAL ABRUPTION: A SYSTEMATIC REVIEW AND META-ANALYSIS (CHAP-SR).

Placental abruption and cardiovascular disease (CVD) have common etiologic underpinnings and there is accumulating evidence that abruption may be associated with future CVD. We estimate 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 comprised of 6,325,152 pregnancies, 69,759 abruptions and 49,265 CHD and stroke cases (1967 to 2016). Risks of the combined CVD morbidity-mortality among abruption and non-abruption groups were 16.7 and 9.3 per 1000 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 for deaths related to CHD/stroke than non-fatal 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.