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Pregnancy Complications and Long-Term Mortality in a Diverse Cohort
Quick Takes
- Adverse pregnancy outcomes including preterm labor, hypertensive disorders of pregnancy, and gestational diabetes were associated with long-term all-cause mortality approximately 50 years after delivery.
- Racial differences in pregnancy complications and associated long-term risk highlight the need for more studies to understand and improve racial disparities.
Study Questions:
What are the associations between pregnancy complications and long-term mortality? Are these associations different in Black and White pregnant women?
Methods:
The Collaborative Perinatal Project collected data on 48,197 pregnant women at 12 US sites (1959-1966). Participants’ vital status was determined through 2016. All-cause and cause-specific mortality was estimated for preterm delivery, hypertensive disorders of pregnancy, and gestational diabetes/impaired glucose tolerance. Cox models adjusted for age, prepregnancy body mass index, smoking, race and ethnicity, previous pregnancies, marital status, income, education, previous medical conditions, site, and year.
Results:
Of 46,551 participants, 45% were Black, 46% were White, median time between index pregnancy and death/censoring was 52 years (interquartile range, 45-54 years). During this time frame, Black women had higher mortality (41%) than White women (37%). Overall pregnancy complications included: preterm delivery (15%), hypertensive disorders of pregnancy (5%), and gestational diabetes/impaired glucose tolerance (1%). Black women had twice as many preterm deliveries as White women (20% vs. 10%). Preterm labor, hypertensive disorders of pregnancy, and gestational diabetes were associated with long-term all-cause mortality. Pregnancy complications were associated with different levels of mortality risk among Black versus White individuals: i.e., preterm induced labor was associated with higher mortality risk in Black individuals, whereas preterm prelabor cesarean delivery carried higher risk in White individuals.
Conclusions:
Pregnancy complications were associated with higher mortality nearly 50 years later. Certain pregnancy complications occur more often in Black individuals and are associated with higher mortality risk. The authors conclude that disparities in pregnancy health may have life-long implications for earlier mortality.
Perspective:
Prior studies have highlighted the long-term implications of adverse pregnancy outcomes. Similarly, this study found that preterm delivery, hypertensive disorders of pregnancy, and impaired glucose tolerance or gestational diabetes were associated with higher mortality risk. This study adds to our understanding by exploring differential levels of risk in a large and racially diverse cohort with long follow-up. Certain pregnancy complications occurred more commonly in Black individuals and were associated with higher mortality risk. Future studies need to continue to improve our understanding of why maternal racial disparities exist and how to resolve them.
Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Prevention, Vascular Medicine, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Hypertension
Keywords: African Americans, Diabetes, Gestational, Glucose Intolerance, Healthcare Disparities, Hypertension, Pregnancy-Induced, Infant, Newborn, Obstetric Labor, Premature, Premature Birth, Pregnancy, Pregnancy Complications, Pregnancy Outcome, Pregnant Women, Risk Factors, Secondary Prevention, Women
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