Pregnancy complications increase risk of early death

Health complications experienced during pregnancy can increase a patient's risk of early death even decades after giving birth, according to a new study.

The survey results are JAMA Internal MedicineCasey Crump, M.D., professor of epidemiology at the University of Texas Health Science Center in Houston and co-author of the report, said the study highlights the importance of incorporating pregnancy history into routine primary care evaluations. .

“Pregnancy provides an important opportunity to identify women at high risk and begin interventions early in life, before other health problems develop,” Crump said.

Using a cohort of 2 million Swedish women who gave birth between 1973 and 2015, Crump and colleagues analyzed data up to almost 50 years after pregnancy. Nearly one in three women gave birth prematurely, and she gave birth to a baby that was small for her. gestation periodhad preeclampsia, gestational diabetesor another form of hypertension.

Women who experienced gestational diabetes had a 52% increased risk of all-cause mortality (hazard ratio) [HR], 1.52; 95% CI, 1.46-1.58). Among the other four adverse pregnancy experiences, the HR was 41% higher for preterm birth (1.41; 95% CI, 1.37-1.44) and smaller for gestational age (1.30; 95% CI, 1.28-1.32) and other hypertensive diseases (1.27). ; 95% CI, 1.19-1.37), and preeclampsia (1.13; 95% CI, 1.10-1.16).

This risk increases independent of factors such as family history and whether siblings have experienced similar complications, the study found. Approximately 8% of women experienced multiple adverse pregnancy outcomes. Previous studies have shown similar results, but the sample size was small or only one of the pregnancy outcomes was evaluated.

Just under half of the deaths were attributed to cancer, 14% to cardiovascular disease, 4% to respiratory disease, 1% to diabetes and 32 to other causes.

“This suggests that there are multiple different underlying pathways, and additional studies are needed to further identify them,” Crump said.

The risk of death was highest for women 10 years after pregnancy, but remained higher for women 32 to 46 years after giving birth than for women whose respective pregnancies did not result. The HRs for 32 to 46 years after birth were: gestational diabetes (1.44; 95% CI, 1.35-1.54), preterm birth (1.36; 95% CI, 1.31-1.41), and small for gestational age ( 1.33; 95% CI, 1.30-1.36), other hypertensive disorders (1.31; 95% CI, 1.14-1.49), and pre-eclampsia (1.16; 95% CI, 1.12-1.20).

of American College of Obstetricians and Gynecologists (ACOG) recommends that women receive continued postpartum care within 3 weeks of birth. ACOG recommends that women with complicated pregnancies or chronic medical conditions should be counseled about their lifetime risk of cardiometabolic disease and referred to their primary care provider for ongoing care.

“Such actions should include reducing risk factors for other chronic diseases throughout the lifespan. obesitylack of exercise, unhealthy diet, smoking, and other symptoms should be properly controlled. high blood pressure And diabetes,” Crump said.

The first 12 weeks postpartum are a critical time for obstetricians and gynecologists to transition care to primary care providers to help prevent long-term complications from high-risk pregnancies, according to Tamika C. Auguste, M.D., president of the Women and Infants Society. It's time. Services at MedStar Washington Hospital Center in Washington, DC.

Auguste said doctors should be aware that all serious adverse pregnancy outcomes are long-term risk factors for early death.

“It's important for primary care physicians to ask about pregnancy history, no matter how long ago it seems,” Auguste says. “As this study suggests, we must keep in mind that pregnancy history influences the non-pregnant status of patients.”

Auguste noted that the study was limited to women in Sweden and may not reflect the medical experiences of racially and ethnically diverse populations in the United States. Many studies suggest that We know that historically marginalized populations are more likely to experience postpartum health care disparities and are at even higher risk of premature death.

“We are already behind the eight ball because of the disparities in maternal mortality due to our country's racial diversity,” Auguste said.

federal law Currently, states are required to provide pregnancy-related Medicaid up to 60 days postpartum. Most states extend postpartum insurance coverage to 12 months.

“I think we are bringing to light concerns about maternal mortality,” Auguste said. “Having this awareness can expand your health options even after pregnancy.”

The research was supported by grants from the National Heart, Lung, and Blood Institute of the National Institutes of Health, the Swedish Heart and Lung Foundation, Lund University in Sweden, and others. The study authors and experts interviewed for this article have disclosed no relevant conflicts of interest.

Lala Salahi is a freelance writer.