{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T21:27:06Z","timestamp":1779312426162,"version":"3.51.4"},"reference-count":35,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,11,15]],"date-time":"2023-11-15T00:00:00Z","timestamp":1700006400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000069","name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000069","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000071","name":"National Institute of Child Health and Human Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000071","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Paediatric Perinatal Epid"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Multifetal gestation could be associated with higher long\u2010term maternal mortality because it increases the risk of pregnancy complications such as preeclampsia and preterm birth, which are in turn linked to postpartum cardiovascular risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>We examined whether spontaneously conceived multifetal versus singleton gestation was associated with long\u2010term maternal mortality in a racially diverse U.S. cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We ascertained vital status as of 2016 via linkage to the National Death Index and Social Security Death Master File of 44,174 mothers from the Collaborative Perinatal Project (CPP; 1959\u20131966). Cox proportional hazards models with maternal age as the time scale assessed associations between history of spontaneous multifetal gestation (in the last CPP observed pregnancy or prior pregnancy) and all\u2010cause and cardiovascular mortality, adjusted for demographics, smoking status, and preexisting medical conditions. We calculated hazard ratios (HR) for all\u2010cause and cause\u2010specific mortality over the study period and until age 50, 60, and 70\u2009years (premature mortality).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of eligible participants, 1672 (3.8%) had a history of multifetal gestation. Participants with versus without a history of multifetal gestation were older, more likely to have a preexisting condition, and more likely to smoke. By 2016, 51% of participants with and 38% of participants without a history of multifetal gestation had died (unadjusted all\u2010cause HR\u20091.14, 95% confidence interval [CI] 1.07, 1.23). After adjustment for smoking and preexisting conditions, a history of multifetal gestation was not associated with all\u2010cause (adjusted HR\u20091.00, 95% CI 0.93, 1.08) or cardiovascular mortality (adjusted HR\u20090.99, 95% CI 0.87, 1.11) over the study period. However, history of multifetal gestation was associated with an 11% lower risk of premature all\u2010cause mortality (adjusted HR\u20090.89, 95% CI 0.82, 0.96).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In a cohort with over 50\u2009years of follow\u2010up, history of multifetal gestation was not associated with all\u2010cause mortality, but may be associated with a lower risk of premature mortality.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ppe.13020","type":"journal-article","created":{"date-parts":[[2023,11,16]],"date-time":"2023-11-16T07:11:10Z","timestamp":1700118670000},"page":"219-226","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["History of multifetal gestation and long\u2010term maternal mortality"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3202-1941","authenticated-orcid":false,"given":"Susanna D.","family":"Mitro","sequence":"first","affiliation":[{"name":"Division of Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Development  Bethesda Maryland USA"},{"name":"Division of Research Kaiser Permanente Northern California  Oakland California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6918-5002","authenticated-orcid":false,"given":"Rajeshwari","family":"Sundaram","sequence":"additional","affiliation":[{"name":"Division of Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Development  Bethesda Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Qiao","sequence":"additional","affiliation":[{"name":"Division of Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Development  Bethesda Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9877-7931","authenticated-orcid":false,"given":"Jessica L.","family":"Gleason","sequence":"additional","affiliation":[{"name":"Division of Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Development  Bethesda Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3851-2613","authenticated-orcid":false,"given":"Edwina","family":"Yeung","sequence":"additional","affiliation":[{"name":"Division of Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Development  Bethesda Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4312-708X","authenticated-orcid":false,"given":"Stefanie N.","family":"Hinkle","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5330-2844","authenticated-orcid":false,"given":"Pauline","family":"Mendola","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Environmental Health, School of Public Health and Health Professions University at Buffalo  Buffalo New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James L.","family":"Mills","sequence":"additional","affiliation":[{"name":"Division of Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Development  Bethesda Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8576-7854","authenticated-orcid":false,"given":"Sonia M.","family":"Grandi","sequence":"additional","affiliation":[{"name":"Division of Epidemiology, Dalla Lana School of Public Health University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0133-3176","authenticated-orcid":false,"given":"Sunni L.","family":"Mumford","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3757-641X","authenticated-orcid":false,"given":"Enrique F.","family":"Schisterman","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8014-2708","authenticated-orcid":false,"given":"Cuilin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Bia\u2010Echo Asia Centre for Reproductive Longevity &amp; 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