Pregnant young woman sitting on a bed preparing insulin dosage in insulin pen before injecting to represent gestational diabetes and other adverse pregnancy outcomes.
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Women who experience any of five adverse pregnancy outcomes are at increased risk for dying for many years after giving birth, according to new research.

“Adverse pregnancy outcomes, including preterm delivery, delivery of a small for gestational age infant, preeclampsia, other hypertensive disorders, and gestational diabetes, have been associated with higher future risks of cardiometabolic disorders,” write lead investigator Casey Crump, a professor at the McGovern Medical School at the University of Texas, and colleagues in JAMA Internal Medicine.

“However, little is known about long-term mortality risks in women who experience adverse pregnancy outcomes. Nearly 30% of all women experience an adverse pregnancy outcome during their reproductive years. A better understanding of long-term mortality risks in this large and growing population of women is needed to facilitate early identification of high-risk women, timely preventive actions, and long-term clinical care.”

To investigate this further, Crump and colleagues carried out the research using data from a national cohort study in Sweden including more than two million women. They reported that over approximately 56 million person-years of follow up, from giving birth until a median age of 52 years, 88,055 women (four percent) of the cohort died.

All five adverse pregnancy outcomes were linked to increased mortality after giving birth.  Over a period of around 46 years of follow-up, having gestational diabetes, preterm delivery, small for gestational age babies, preeclampsia, and other hypertensive disorders, increased a women’s risk of dying by 52%, 41%, 30%, 13%, and 27%, respectively, compared to no adverse birth outcome.

A study of siblings of the affected women showed these findings could only partly be explained by genetic or environmental influences.

The researchers found that the increase in risk in these women remained high even after 30–46 years had elapsed. They also note that multiple adverse pregnancy outcomes increased a woman’s mortality risk still further.

“All five major adverse pregnancy outcomes should now be recognized as long-term risk factors for premature mortality,” conclude the authors.

“Women with adverse pregnancy outcomes need early preventive actions and long-term follow-up for timely detection and treatment of chronic disorders associated with early mortality.”

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