Integrated cardiometabolic and nutritional risk profiling identifies pregnancy loss as a marker of systemic metabolic vulnerability

Background

Pregnancy loss has important implications for women’s health. Although maternal age is a well-established risk factor, the contribution of routinely measured cardiometabolic and behavioral markers at population-scale remains incompletely characterized.

Objective

To examine associations between cardiometabolic, nutritional, and behavioral risk markers and pregnancy loss among U.S. women of reproductive age.

Methods

We conducted a cross-sectional analysis of 4,842 U.S. women aged 20–44 years with ≥1 pregnancy using the National Health and Nutrition Examination Survey data (2013–2023). Pregnancy loss was defined as ≥1 prior miscarriages. Exposures included body mass index, smoking exposure (cotinine), lipid biomarkers, vitamin D and folate, and a composite cardiometabolic–nutritional risk score. Survey-weighted logistic regression estimated adjusted odds ratios (aORs) and 95% confidence intervals, with bootstrap resampling for predictor robustness.

Results

The weighted prevalence of pregnancy loss was 23%. Higher odds of pregnancy loss were associated with increasing age (aOR per year=1.02; 95% CI: 1.00–1.04), Non-Hispanic Black race (aOR=1.32; 95% CI: 1.00–1.74), overweight (aOR=1.56; 95% CI: 1.16–2.11), obesity (aOR=2.06; 95% CI: 1.39–3.05), and smoking (aOR=1.58; 95% CI: 1.19–2.10).

Adverse lipid profiles, particularly elevated triglycerides (aOR=1.83; 95% CI: 1.16–2.90) and high low-density lipoprotein (aOR=2.97; 95% CI: 1.45–6.61), were independently associated with pregnancy loss. Vitamin D/folate were not stable predictors. Higher composite cardiometabolic–nutritional risk scores were observed among women with pregnancy loss (P=0.026).

Conclusion

Pregnancy loss clustered with adverse cardiometabolic and behavioral risk markers in a nationally representative population. These findings highlight pregnancy loss as a marker of broader metabolic vulnerability supporting the need for longitudinal studies and cardiometabolic profiling to inform preconception care and risk stratification.