title: Maternal Obesity During Pregnancy Associates With Premature Mortality and Major Cardiovascular Events in Later Life.
abstract: One in 5 pregnant women is obese but the impact on later health is unknown. We aimed to determine whether maternal obesity during pregnancy associates with increased premature mortality and later life major cardiovascular events. Maternity records of women who gave birth to their first child between 1950 and 1976 (n=18 873) from the Aberdeen Maternity and Neonatal databank were linked to the National Register of Deaths, Scotland and Scottish Morbidity Record. The effect of maternal obesity at first antenatal visit on death and hospital admissions for cardiovascular events was tested using time-to-event analysis with Cox proportional hazard regression to compare outcomes of mothers in underweight, overweight, or obese body mass index (BMI) categories compared with normal BMI. Median follow-up was at 73 years. All-cause mortality was increased in women who were obese during pregnancy (BMI>30 kg/m(2)) versus normal BMI after adjustment for socioeconomic status, smoking, gestation at BMI measurement, preeclampsia, and low birth weight (hazard ratio, 1.35; 95% confidence interval, 1.02-1.77). In adjusted models, overweight and obese mothers had increased risk of hospital admission for a cardiovascular event (1.16; 1.06-1.27 and 1.26; 1.01-1.57) compared with normal BMI mothers. Adjustment for parity largely unchanged the hazard ratios (mortality: 1.43, 1.09-1.88; cardiovascular events overweight: 1.17, 1.07-1.29; and obese: 1.30, 1.04-1.62). In conclusion, maternal obesity is associated with increased risk of premature death and cardiovascular disease. Pregnancy and early postpartum could represent an opportunity for interventions to identify obesity and reduce its adverse consequences.
authors.affiliation: From the Endocrinology Unit, BHF/University Centre for Cardiovascular Science (K.K.L., R.M.R.) and Tommy's Centre for Fetal and Maternal Health, Medical Research Council Centre for Reproductive Health (J.E.N., R.M.R.), Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; and Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom (E.A.R., A.J.L., Sohinee Bhattacharya, Siladitya Bhattacharya).
authors.forename: Kuan Ken
authors.initials: KK
authors.lastname: Lee
authors.affiliation: From the Endocrinology Unit, BHF/University Centre for Cardiovascular Science (K.K.L., R.M.R.) and Tommy's Centre for Fetal and Maternal Health, Medical Research Council Centre for Reproductive Health (J.E.N., R.M.R.), Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; and Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom (E.A.R., A.J.L., Sohinee Bhattacharya, Siladitya Bhattacharya).
authors.forename: Edwin A
authors.initials: EA
authors.lastname: Raja
authors.affiliation: From the Endocrinology Unit, BHF/University Centre for Cardiovascular Science (K.K.L., R.M.R.) and Tommy's Centre for Fetal and Maternal Health, Medical Research Council Centre for Reproductive Health (J.E.N., R.M.R.), Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; and Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom (E.A.R., A.J.L., Sohinee Bhattacharya, Siladitya Bhattacharya).
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Lee
authors.affiliation: From the Endocrinology Unit, BHF/University Centre for Cardiovascular Science (K.K.L., R.M.R.) and Tommy's Centre for Fetal and Maternal Health, Medical Research Council Centre for Reproductive Health (J.E.N., R.M.R.), Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; and Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom (E.A.R., A.J.L., Sohinee Bhattacharya, Siladitya Bhattacharya).
authors.forename: Sohinee
authors.initials: S
authors.lastname: Bhattacharya
authors.affiliation: From the Endocrinology Unit, BHF/University Centre for Cardiovascular Science (K.K.L., R.M.R.) and Tommy's Centre for Fetal and Maternal Health, Medical Research Council Centre for Reproductive Health (J.E.N., R.M.R.), Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; and Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom (E.A.R., A.J.L., Sohinee Bhattacharya, Siladitya Bhattacharya).
authors.forename: Siladitya
authors.initials: S
authors.lastname: Bhattacharya
authors.affiliation: From the Endocrinology Unit, BHF/University Centre for Cardiovascular Science (K.K.L., R.M.R.) and Tommy's Centre for Fetal and Maternal Health, Medical Research Council Centre for Reproductive Health (J.E.N., R.M.R.), Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; and Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom (E.A.R., A.J.L., Sohinee Bhattacharya, Siladitya Bhattacharya).
authors.forename: Jane E
authors.initials: JE
authors.lastname: Norman
authors.affiliation: From the Endocrinology Unit, BHF/University Centre for Cardiovascular Science (K.K.L., R.M.R.) and Tommy's Centre for Fetal and Maternal Health, Medical Research Council Centre for Reproductive Health (J.E.N., R.M.R.), Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; and Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom (E.A.R., A.J.L., Sohinee Bhattacharya, Siladitya Bhattacharya). R.Reynolds@ed.ac.uk.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Reynolds
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D008875:Middle Aged; D061213:Mortality, Premature / Q000639:trends*; D009765:Obesity / Q000150:complications* / Q000503:physiopathology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis* / Q000503:physiopathology; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D012606:Scotland / Q000453:epidemiology
keywords: body mass index; cardiovascular diseases; death; obesity; pregnancy