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Mortality of mothers from cardiovascular and non-cardiovascular causes following pregnancy complications in first delivery

Authors

  • Jacob A. Lykke,

    Corresponding author
    1. Department of Obstetrics and Gynaecology, Roskilde Hospital, Roskilde, and
    2. Department. of Obstetrics, Rigshospitalet, Copenhagen, Denmark,
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  • Jens Langhoff-Roos,

    1. Department. of Obstetrics, Rigshospitalet, Copenhagen, Denmark,
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  • Charles J. Lockwood,

    1. Yale Women and Children's Center for Blood Disorders, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, and
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  • Elizabeth W. Triche,

    1. Department of Community Health, Section of Epidemiology, Brown University School of Medicine, Providence, RI, USA
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  • Michael J. Paidas

    1. Yale Women and Children's Center for Blood Disorders, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, and
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Jacob Alexander Lykke, MD, Department of Obstetrics and Gynecology, Roskilde Hospital, Køgevej 7-9, SN.P. 4000 Roskilde, Denmark.
E-mail: dr.lykke@dadlnet.dk

Summary

Lykke JA, Langhoff-Roos J, Lockwood CJ, Triche EW, Paidas MJ. Mortality of mothers from cardiovascular and non-cardiovascular causes following pregnancy complications in first delivery. Paediatric and Perinatal Epidemiology 2010.

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.

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