title: Morbidity and mortality after childbirth in women with Turner karyotype.
abstract: OBJECTIVE
  Do women with Turner karyotype have increased mortality and morbidity in the years after childbirth?
  
  
  CONCLUSIONS
  No mortality occurred during pregnancy and follow-up in women with Turner karyotype, but a higher rate of circulatory and endocrine diseases and a high risk of aortic aneurysm were confirmed.
  
  
  BACKGROUND
  Pregnancies in women with Turner karyotype are high-risk pregnancies with an increased risk of maternal mortality from aortic dissection and morbidity from hypertensive disorders.
  
  
  METHODS
  A retrospective Swedish population-based registry study of 124 women with Turner karyotype born between 1957 and 1987 and who gave birth between 1973 and 2010. Women with Turner karyotype without childbirth (n = 378) were selected as controls. A second control group consisted of women from the Swedish Medical Birth Register (MBR) (n = 1230) matched for maternal age, number of children and year of birth of the first child.
  
  
  METHODS
  Women with Turner karyotype were identified in the Swedish Genetic Turner Register. Data were obtained by using the unique personal identification number with cross linkage to the Swedish MBR, the Cause of Death Register, the National Patient Register and the Swedish Cancer Register. Hazard ratio (HR) with 95% confidence interval (CI) was used in the analysis of morbidity.
  
  
  RESULTS
  No mortality occurred in women with Turner karyotype and childbirth. Diseases of the circulatory system occurred more often in women with Turner syndrome under the age of 40 years compared with the MBR control group (HR 4.59; 95% CI 2.75-7.66) but was similar at or above the age of 40 years. Morbidity from circulatory diseases was increased before pregnancy (HR 3.83; 95% CI 1.02-14.43) and during pregnancy or within 1 year after (HR 5.78; 95% CI 1.94-17.24), but was similar after 1 or more years after delivery (HR 1.91; 95% CI 0.74-4.96). Aortic aneurysm occurred in 11/502 (2.2%) women with Turner karyotype and in three women (2.4%) during pregnancy. The long-term follow-up showed that aortic dissection was a common cause of death in young women with Turner karyotype without childbirth. A thorough cardiac evaluation before pregnancy in women with Turner karyotype is of utmost importance.
  
  
  CONCLUSIONS
  Although this was a population-based registry study performed over a period of more than 20 years, a much longer follow-up and larger series are needed to assess rare events. The study also lacks information on phenotype and mode of conception in women with Turner karyotype. Women who gave birth probably represent a selection of healthier women with Turner karyotype.
  
  
  CONCLUSIONS
  The high risk of aortic aneurysm in young women with Turner karyotype is in agreement with the literature.
authors.affiliation: Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, SE-416 85 Gothenburg, Sweden. anna.c.hagman@vgregion.se
authors.forename: Anna
authors.initials: A
authors.lastname: Hagman
authors.forename: Karin
authors.initials: K
authors.lastname: Källén
authors.forename: Inger
authors.initials: I
authors.lastname: Bryman
authors.forename: Kerstin
authors.initials: K
authors.lastname: Landin-Wilhelmsen
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Barrenäs
authors.forename: Ulla-Britt
authors.initials: UB
authors.lastname: Wennerholm
mesh_terms: D000328:Adult; D001014:Aortic Aneurysm / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications; D036801:Parturition; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000235:genetics; D012189:Retrospective Studies; D018570:Risk Assessment; D014424:Turner Syndrome / Q000150:complications* / Q000235:genetics
keywords: Turner syndrome; karyotype; morbidity; mortality; pregnancy