HIGHER mortality risk persists in females who experience preterm birth, small for gestational age infants, preeclampsia, hypertensive disorders, or gestational diabetes, even 40 years after giving birth, suggests a study by Casey Crump, McGovern Medical School and the University of Texas Health Sciences Centre, Houston, USA, and colleagues.
The team carried out a nationwide cohort investigation utilising data from the Swedish Medical Birth Register to locate 2,195,667 females (median age at delivery: 27 years) who had a single childbirth between 1973–2015, with information on pregnancy duration and infant birth weight. The researchers classified preterm birth, small for gestational age, preeclampsia, hypertensive disorders, and gestational diabetes as significant adverse pregnancy outcomes, and tracked deaths through the Swedish Death Register. The primary focus was on all-cause and cause-specific mortality.
Throughout 56 million person-years of observation, 4% of the females passed away, with a median age at death of 59 years. Approximately 30% of females faced at least one adverse pregnancy outcome, while 8% encountered two or more. The prevalent adverse outcomes arising in deliveries were small for gestational age infants (10%) and preterm birth (5%), affecting 14% and 8% of all females during their reproductive years, respectively.
Gestational diabetes (adjusted hazard ratio [aHR]: 1.52; 95% confidence interval [CI]: 1.46–1.58), preterm birth (aHR: 1.41; 95% CI: 1.37–1.44), small for gestational age (aHR: 1.3; 95% CI: 1.28–1.32), hypertensive disorders (aHR: 1.27; 95% CI: 1.19–1.37), and preeclampsia (aHR: 1.13; 95% CI: 1.10–1.16) each showed independent links to all-cause mortality. These connections persisted, with heightened risk, for 30–46 years following childbirth.
In total, 14% of deaths were due to cardiovascular disease, 49% to cancer, 4% to respiratory disorders, 1% to diabetes, and 32% to other causes. Major adverse pregnancy outcomes correlated with a 1.5–2.5 times higher risk of cardiovascular disease mortality. Females with preterm birth or small infants had over double the respiratory mortality risk, and 1.1–1.2 times higher cancer mortality risk. Those with preterm birth or preeclampsia faced double the diabetes mortality risk, while gestational diabetes increased the risk 25-fold. After 30–46 years post-delivery, females with one, two, or three adverse pregnancy outcomes had mortality risks elevated by 1.27, 1.56, and 1.84 times, respectively, compared to those without such outcomes.
Researchers emphasised the need for recognising all major adverse pregnancy outcomes as long-term risk factors for premature mortality, and advocated for early preventive measures, and ongoing monitoring for timely detection and management of associated chronic disorders.
Reference
Crump C et al. Adverse pregnancy outcomes and long-term mortality in women. JAMA Intern Med. 2024;DOI:10.1001/jamainternmed.2024.0276.
