{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:53:00Z","timestamp":1792173180453,"version":"4.4.0"},"reference-count":46,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"13","license":[{"start":{"date-parts":[[2023,3,28]],"date-time":"2023-03-28T00:00:00Z","timestamp":1679961600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2023,3,28]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Pregnancy complications are associated with increased risk of development of cardiometabolic diseases and earlier mortality. However, much of the previous research has been limited to White pregnant participants. We aimed to investigate pregnancy complications in association with total and cause-specific mortality in a racially diverse cohort and evaluate whether associations differ between Black and White pregnant participants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>The Collaborative Perinatal Project was a prospective cohort study of 48\u2009197 pregnant participants at 12 US clinical centers (1959\u20131966). The Collaborative Perinatal Project Mortality Linkage Study ascertained participants\u2019 vital status through 2016 with linkage to the National Death Index and Social Security Death Master File. Adjusted hazard ratios (aHRs) for underlying all-cause and cause-specific mortality were estimated for preterm delivery (PTD), hypertensive disorders of pregnancy, and gestational diabetes\/impaired glucose tolerance (GDM\/IGT) using Cox models adjusted for age, prepregnancy body mass index, smoking, race and ethnicity, previous pregnancies, marital status, income, education, previous medical conditions, site, and year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Among 46\u2009551 participants, 45% (21\u2009107 of 46\u2009551) were Black, and 46% (21\u2009502 of 46\u2009551) were White. The median time between the index pregnancy and death\/censoring was 52 years (interquartile range, 45\u201354). Mortality was higher among Black (8714 of 21\u2009107 [41%]) compared with White (8019 of 21\u2009502 [37%]) participants. Overall, 15% (6753 of 43\u2009969) of participants had PTD, 5% (2155 of 45\u2009897) had hypertensive disorders of pregnancy, and 1% (540 of 45\u2009890) had GDM\/IGT. PTD incidence was higher in Black (4145 of 20\u2009288 [20%]) compared with White (1941 of 19\u2009963 [10%]) participants. The following were associated with all-cause mortality: preterm spontaneous labor (aHR, 1.07 [95% CI, 1.03\u20131.1]); preterm premature rupture of membranes (aHR, 1.23 [1.05\u20131.44]); preterm induced labor (aHR, 1.31 [1.03\u20131.66]); preterm prelabor cesarean delivery (aHR, 2.09 [1.75\u20132.48]) compared with full-term delivery; gestational hypertension (aHR, 1.09 [0.97\u20131.22]); preeclampsia or eclampsia (aHR, 1.14 [0.99\u20131.32]) and superimposed preeclampsia or eclampsia (aHR, 1.32 [1.20\u20131.46]) compared with normotensive; and GDM\/IGT (aHR, 1.14 [1.00\u20131.30]) compared with normoglycemic.\n                      <jats:italic>P<\/jats:italic>\n                      values for effect modification between Black and White participants for PTD, hypertensive disorders of pregnancy, and GDM\/IGT were 0.009, 0.05, and 0.92, respectively. Preterm induced labor was associated with greater mortality risk among Black (aHR, 1.64 [1.10\u20132.46]) compared with White (aHR, 1.29 [0.97\u20131.73]) participants, while preterm prelabor cesarean delivery was higher in White (aHR, 2.34 [1.90\u20132.90]) compared with Black (aHR, 1.40 [1.00\u20131.96]) participants.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In this large, diverse US cohort, pregnancy complications were associated with higher mortality nearly 50 years later. Higher incidence of some complications in Black individuals and differential associations with mortality risk suggest that disparities in pregnancy health may have life-long implications for earlier mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.122.062177","type":"journal-article","created":{"date-parts":[[2023,3,8]],"date-time":"2023-03-08T05:01:16Z","timestamp":1678251676000},"page":"1014-1025","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":65,"title":["Pregnancy Complications and Long-Term Mortality in a Diverse Cohort"],"prefix":"10.1161","volume":"147","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4312-708X","authenticated-orcid":true,"given":"Stefanie N.","family":"Hinkle","sequence":"first","affiliation":[{"name":"Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (S.N.H., E.F.S., S.L.M)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrique F.","family":"Schisterman","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (S.N.H., E.F.S., S.L.M)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5483-6303","authenticated-orcid":true,"given":"Danping","family":"Liu","sequence":"additional","affiliation":[{"name":"Division of Cancer Epidemiology and Genetics, National Cancer Institute (D.L.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4313-3298","authenticated-orcid":true,"given":"Anna Z.","family":"Pollack","sequence":"additional","affiliation":[{"name":"Global and Community Health Department, College of Health and Human Services, George Mason University, Fairfax, VA (A.Z.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edwina H.","family":"Yeung","sequence":"additional","affiliation":[{"name":"Division of Population Health Research, Division of Intramural Research (E.H.Y., K.L.G., N.J.P., J.L.M.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunni L.","family":"Mumford","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (S.N.H., E.F.S., S.L.M)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine L.","family":"Grantz","sequence":"additional","affiliation":[{"name":"Division of Population Health Research, Division of Intramural Research (E.H.Y., K.L.G., N.J.P., J.L.M.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5005-5996","authenticated-orcid":true,"given":"Yan","family":"Qiao","sequence":"additional","affiliation":[{"name":"The Prospective Group, Rockville, MD (Y.Q.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil J.","family":"Perkins","sequence":"additional","affiliation":[{"name":"Division of Population Health Research, Division of Intramural Research (E.H.Y., K.L.G., N.J.P., J.L.M.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James L.","family":"Mills","sequence":"additional","affiliation":[{"name":"Division of Population Health Research, Division of Intramural Research (E.H.Y., K.L.G., N.J.P., J.L.M.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pauline","family":"Mendola","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, NY (P.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8014-2708","authenticated-orcid":true,"given":"Cuilin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Global Centre for Asian Women\u2019s Health, Human Potential Translational Research Program; 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