Recurrent miscarriage increases a woman’s chance of having a heart attack fivefold in later life, indicates research published online in the journal Heart.

Research indicates that miscarriage is one of the commonest complications of pregnancy, occurring in up to one in five pregnancies.

The authors base their findings on more than 11,500 women who were taking part in the Heidelberg arm of EPIC, a large European study that is tracking the impact of diet and lifestyle on disease, particularly cancer.

All the women had been pregnant at least once, and the authors were particularly interested in those whose pregnancies had ended prematurely, either as a result of miscarriage or abortion, or whose babies had been stillborn.

Among the entire group, almost one in four (25%) had had at least one detectable miscarriage, while almost one in five (18%) had had at least one abortion. A further 2% had experienced a stillbirth.

Of those 2876 women who had miscarried, 69 had done so more than three times. These women tended to weigh more; those who had experienced a stillbirth were less physically active and higher rates of diabetes and high blood pressure, all of which are independent risk factors for heart attack and stroke.

Over a period of around 10 years, 82 women had a heart attack and 112 had a stroke.

No significant association was found between any of the types of pregnancy loss and an increased risk of stroke. But strong patterns emerged for stillbirth and miscarriage.

But having at least one stillbirth increased the risk of a heart attack by 3.5 times. But those women who had had more than three miscarriages were nine times as likely to have a heart attack.

The magnitude of the risk fell after adjusting for influential factors, such as weight, smoking, and alcohol consumption but it was still high, being five times as great.

Each miscarriage increased heart attack risk by 40% and those women who miscarried more than twice were more than four times as likely to have a heart attack.

“These results suggest that women who experienced spontaneous pregnancy loss are at a substantially higher risk of [heart attack] later in life,” comment the authors.

“Recurrent miscarriage and stillbirth are strong gender predictors for [this] and thus should be considered as important indicators for monitoring cardiovascular risk factors and preventive measures,” they add.

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BMJ-British Medical Journal