ImportanceWomen with adverse pregnancy outcomes, such as preterm delivery or preeclampsia, have higher future risks of cardiometabolic disorders; however, little is known about their long-term mortality risks. A better understanding of such risks is needed to facilitate early identification of high-risk women and preventive actions.ObjectiveTo determine long-term mortality risks associated with 5 major adverse pregnancy outcomes in a large population-based cohort of women.Design, Setting, and ParticipantsThis national cohort study in Sweden used the Swedish Medical Birth Register, containing prenatal and birth information for nearly all deliveries in Sweden since 1973, to identify women who had a singleton delivery during 1973 to 2015. All 2 195 667 such women with information for pregnancy duration and infant birth weight were included in the study. Data were analyzed from March to September 2023.ExposureAdverse pregnancy outcomes (preterm delivery, small for gestational age, preeclampsia, other hypertensive disorders, and gestational diabetes), identified from nationwide birth records.Main Outcome and MeasuresAll-cause and cause-specific mortality through December 31, 2018. Cox regression was used to compute hazard ratios (HRs) for mortality associated with specific adverse pregnancy outcomes, adjusted for other maternal factors. Cosibling analyses assessed for confounding by shared familial (genetic or environmental) factors.ResultsIn 56 million person-years of follow-up to a median (IQR) age of 52 (42-61) years, 88 055 women (4%) died (median [IQR] age at death, 59 [50-67] years). All 5 adverse pregnancy outcomes were independently associated with increased mortality. Across the entire follow-up (≤46 years after delivery), adjusted HRs for all-cause mortality associated with specific adverse pregnancy outcomes were as follows: gestational diabetes, 1.52 (95% CI, 1.46-1.58); preterm delivery, 1.41 (95% CI, 1.37-1.44); small for gestational age, 1.30 (95% CI, 1.28-1.32); other hypertensive disorders, 1.27 (95% CI, 1.19-1.37); and preeclampsia, 1.13 (95% CI, 1.10-1.16). All HRs remained significantly elevated even 30 to 46 years after delivery. These effect sizes were only partially (0%-45%) reduced after controlling for shared familial factors in cosibling analyses. Women who experienced multiple adverse pregnancy outcomes had further increases in risk. Several major causes of death were identified, including cardiovascular and respiratory disorders and diabetes.Conclusions and RelevanceIn this large national cohort study, women who experienced any of 5 major adverse pregnancy outcomes had increased mortality risks that remained elevated more than 40 years later. Women with adverse pregnancy outcomes need early preventive evaluation and long-term follow-up for detection and treatment of chronic disorders associated with premature mortality.

中文翻译：

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女性不良妊娠结局和长期死亡率

重要性 患有不良妊娠结局（例如早产或先兆子痫）的女性未来患心脏代谢疾病的风险较高；然而，人们对其长期死亡风险知之甚少。需要更好地了解此类风险，以便及早识别高危女性并采取预防措施。目的确定与大量女性人群中 5 种主要不良妊娠结局相关的长期死亡风险。设计、设置和参与者瑞典的这项全国队列研究使用了瑞典医学出生登记册，其中包含自 1973 年以来瑞典几乎所有分娩的产前和出生信息，以确定 1973 年至 2015 年间单胎分娩的妇女。所有 2 195 667 名此类妇女都有怀孕信息该研究包括持续时间和婴儿出生体重。数据分析时间为 2023 年 3 月至 9 月。暴露从全国出生记录中确定的不良妊娠结局（早产、小于胎龄、先兆子痫、其他高血压疾病和妊娠糖尿病）。主要结果和措施通过2018 年 12 月 31 日。Cox 回归用于计算与特定不良妊娠结局相关的死亡率的风险比 (HR)，并根据其他孕产妇因素进行调整。共同兄弟姐妹分析评估了共同家族（遗传或环境）因素的混杂因素。结果在 5600 万人年的随访中，中位年龄 (IQR) 为 52 (42-61) 岁，88 055 名女性 (4%) 死亡（死亡年龄中位数 [IQR] 为 59 [50-67] 岁）。所有 5 种不良妊娠结局均与死亡率增加独立相关。在整个随访期间（产后 46 年以内），与特定不良妊娠结局相关的全因死亡率的调整 HR 如下：妊娠期糖尿病，1.52（95% CI，1.46-1.58）；早产，1.41（95% CI，1.37-1.44）；小于胎龄，1.30（95% CI，1.28-1.32）；其他高血压疾病，1.27（95% CI，1.19-1.37）；和先兆子痫，1.13（95% CI，1.10-1.16）。即使在分娩后 30 至 46 年，所有 HR 仍显着升高。在共同分析中控制共同的家族因素后，这些效应大小仅部分降低（0%-45%）。经历过多次不良妊娠结局的女性的风险进一步增加。确定了几个主要死亡原因，包括心血管和呼吸系统疾病以及糖尿病。 结论和相关性在这项大型全国队列研究中，经历过 5 种主要不良妊娠结局中任何一种的女性死亡风险增加，并且在 40 多年后仍然保持较高水平。妊娠结局不良的女性需要早期预防性评估和长期随访，以发现和治疗与过早死亡相关的慢性疾病。