title: Mortality of mothers from cardiovascular and non-cardiovascular causes following pregnancy complications in first delivery.
abstract: The combined effects of preterm delivery, small-for-gestational-age offspring, hypertensive disorders of pregnancy, placental abruption and stillbirth on early maternal death from cardiovascular causes have not previously been described in a large cohort. We investigated the effects of pregnancy complications on early maternal death in a registry-based retrospective cohort study of 782 287 women with a first singleton delivery in Denmark 1978-2007, followed for a median of 14.8 years (range 0.25-30.2) accruing 11.6 million person-years. We employed Cox proportional hazard models of early death from cardiovascular and non-cardiovascular causes following preterm delivery, small-for-gestational-age offspring and hypertensive disorders of pregnancy. We found that preterm delivery and small-for-gestational-age were both associated with subsequent death of mothers from cardiovascular and non-cardiovascular causes. Severe pre-eclampsia was associated with death from cardiovascular causes only. There was a less than additive effect on cardiovascular mortality hazard ratios with increasing number of pregnancy complications: preterm delivery 1.90 [95% confidence intervals 1.49, 2.43]; preterm delivery and small-for-gestational-age offspring 3.30 [2.25, 4.84]; preterm delivery, small-for-gestational-age offspring and pre-eclampsia 3.85 [2.07, 7.19]. Thus, we conclude that, separately and combined, preterm delivery and small-for-gestational-age are strong markers of early maternal death from both cardiovascular and non-cardiovascular causes, while hypertensive disorders of pregnancy are markers of early death of mothers from cardiovascular causes.
authors.affiliation: Department of Obstetrics and Gynaecology, Roskilde Hospital, SN.P. 4000 Roskilde, Denmark. dr.lykke@dadlnet.dk
authors.forename: Jacob A
authors.initials: JA
authors.lastname: Lykke
authors.forename: Jens
authors.initials: J
authors.lastname: Langhoff-Roos
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Lockwood
authors.forename: Elizabeth W
authors.initials: EW
authors.lastname: Triche
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Paidas
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000401:mortality*; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D008297:Male; D008427:Maternal Health Services; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality*; D047928:Premature Birth / Q000453:epidemiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors