Postpartum hemorrhage and long-term cardiovascular disease risk: a comprehensive systematic review and meta-analysis

Purpose: Postpartum hemorrhage (PPH) is a major contributor to maternal morbidity and mortality and may have long-term consequences on cardiovascular health. This systematic review and meta-analysis aimed to evaluate the association between PPH and the subsequent risk of cardiovascular disease (CVD) in women. Materials and methods: A comprehensive literature search was conducted across major databases to identify cohort studies assessing cardiovascular outcomes in women with a history of PPH. Data from over 9.7 million participants were pooled using a random-effects model to account for inter-study heterogeneity. The primary outcomes included cardiovascular diseases and thromboembolism events. Subgroup analyses were conducted separately for cardiovascular and thromboembolism outcomes. Sensitivity analyses were conducted to examine the consistency and robustness of the pooled estimates. Results: Women with a history of PPH had a 1.76-fold increased risk of developing cardiovascular disease and 2.10-fold increased risk of thromboembolism. The risk was particularly elevated among those requiring transfusion. Cardiovascular risk was most frequent during the first year postpartum and persisted for up to 15 years, particularly among those with hypertensive disorders of pregnancy. Heterogeneity was substantial for cardiovascular disease outcome (I²=99%) and moderate for thromboembolic outcomes (I²=43%). Sensitivity analyses reduced heterogeneity for cardiovascular disease to 77.1%. Conclusions: PPH is associated with a significantly increased long-term risk of both cardiovascular and thromboembolism disease. These findings highlight the importance of postpartum cardiovascular risk screening and preventive interventions in women with a history of severe PPH. Future research should adopt standardized methodologies and focus on high-burden settings, particularly in low- and middle-income countries.

研究目的：产后出血（Postpartum hemorrhage, PPH）是孕产妇发病与死亡的主要诱因之一，且可能对心血管健康造成长期不良影响。本系统综述与荟萃分析旨在探讨产后出血史与女性后续罹患心血管疾病（cardiovascular disease, CVD）的风险之间的关联。
材料与方法：本研究通过对主流学术数据库开展全面文献检索，筛选纳入评估有产后出血史女性心血管结局的队列研究。研究共纳入超970万例参与者的数据，采用随机效应模型进行数据合并，以控制研究间异质性。主要结局指标包括心血管疾病与血栓栓塞事件。针对心血管疾病与血栓栓塞结局分别开展亚组分析；通过敏感性分析检验合并效应量的一致性与稳健性。
结果：有产后出血史的女性罹患心血管疾病的风险升高1.76倍，发生血栓栓塞事件的风险升高2.10倍；其中需接受输血治疗的患者风险升高尤为显著。心血管风险多在产后第一年达到峰值，且可持续长达15年，尤其在合并妊娠高血压疾病的女性中更为突出。心血管疾病结局存在显著异质性（I²=99%），血栓栓塞结局异质性为中度（I²=43%）；经敏感性分析后，心血管疾病结局的异质性降至77.1%。
结论：产后出血与女性长期罹患心血管疾病及血栓栓塞疾病的风险显著升高相关。本研究结果凸显了对有重度产后出血史的女性开展产后心血管风险筛查与预防性干预的重要性。未来研究应采用标准化研究方法，并聚焦于疾病负担较重的地区，尤其是中低收入国家。