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

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 National Death Index (NDI), which provides valuable cause of death information, were previously lacking. This presents a major data gap. To address this gap, the Collaborative Perinatal Project (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 CPP with mortality records provided a unique opportunity for insight on associations between gravid conditions and the longest follow up of mortality for U.S. women. Novel findings have been identified on long-term health implications of pregnancy conditions (such as gestational diabetes, preeclampsia, preterm birth, pregnancy loss, placental characteristics, plurality, and gestational weight gain) to causes of maternal death 50+ years later (e.g., cardiovascular disease, cancer, and renal diseases). Ongoing topics include investigating associations of postpartum weight retention.