Pregnancy and perinatal complications and mortality: Collaborative Perinatal Project mortality linkage study

Eunice Kennedy Shriver National Institute Of Child Health & Human Development

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Abstract

o Pregnancy is a common event that imposes significant stresses on maternal physiology, with substantive changes in metabolism, hemodynamics, and hormone levels that can expose underlying disease risks for women. While studies linking pregnancy events to mortality have been feasible using nationally linked health records in European nations, such linkages are less common in the US. Detailed pregnancy records with the ability to be linked to the NDI, which provides valuable cause of death information, were previously lacking. This presents a major data gap, as the US population has a different race/ethnic make-up, in particular African Americans who are known to have an increased risk for cardiovascular diseases and earlier death compared to whites. To address this gap, the CPP Mortality Linkage Study linked women who participated in the CPP with the NDI. The CPP was a prospective cohort study of 48,197 women with 55,908 pregnancies and 54,390 births at 12 university clinical centers across the US from 1959-1965. Detailed information on demographics, medical history, socioeconomic status, and behavior were collected via interviews at enrollment. Physical exams were performed, and blood samples collected throughout pregnancy. Children were followed to age 7 years. Approximately 46.2% of the enrolled women were white, 46.0% were black, 6.8% were Hispanic, and 1% of Asian or other descent. Progress Personal identifying data was successfully abstracted on 46,428 (97%) CPP participants from the original participant records archived in microfiche. The linkage with the NDI was completed in 2017. Using the NDI, a total of 35% of participants were identified as deceased as of 2016, which was consistent with an expected mortality of 39%. Initial analyses demonstrated the success of the linkage (Pollack and Hinkle et al. Epidemiology 2020), which opens doors to a series of research on lifelong health implications of pregnancy conditions. The successful linkage of the Collaborative Perinatal Project with mortality records offers a unique opportunity for insight on associations between gravid conditions and the longest follow up of mortality for U.S. women. Novel findings were identified, and multiple projects are ongoing to investigate long-term health implications of pregnancy health conditions by linking pregnancy health and events (e.g., gestational diabetes, preeclampsia, preterm birth, pregnancy loss, placental characteristics) to causes of maternal death 50+ years later (e.g., cardiovascular disease, cancer, and renal diseases).