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

<b>Purpose:</b> 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. <b>Materials and methods:</b> 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. <b>Results:</b> 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 (<i>I</i>^²=99%) and moderate for thromboembolic outcomes (<i>I</i>^²=43%). Sensitivity analyses reduced heterogeneity for cardiovascular disease to 77.1%. <b>Conclusions:</b> 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.

<b>目的：</b>产后出血（postpartum hemorrhage, PPH）是孕产妇发病率和死亡率的主要原因，且可能对心血管健康产生长期影响。本系统综述和荟萃分析旨在评估女性中PPH与后续心血管疾病（cardiovascular disease, CVD）风险之间的关联。<b>材料与方法：</b>通过在主要数据库中进行全面文献检索，识别评估有PPH病史女性心血管结局的队列研究。采用随机效应模型对超过970万名参与者的数据进行合并，以解释研究间异质性。主要结局包括心血管疾病和血栓栓塞事件。针对心血管和血栓栓塞结局分别进行亚组分析。<b>结果：</b>有PPH病史的女性发生心血管疾病的风险增加1.76倍，发生血栓栓塞的风险增加2.10倍。需要输血的女性风险尤其升高。心血管风险在产后第一年最为常见，并持续长达15年，尤其是在患有妊娠期高血压疾病的女性中。心血管疾病结局的异质性显著（I²=99%），血栓栓塞结局的异质性中等（I²=43%）。敏感性分析将心血管疾病的异质性降至77.1%。<b>结论：</b>PPH与心血管疾病和血栓栓塞疾病的长期风险显著增加相关。这些发现强调了对有严重PPH病史的女性进行产后心血管风险筛查和预防性干预的重要性。未来研究应采用标准化方法，并关注高负担地区，尤其是低收入和中等收入国家。