High weight gain in pregnancy is associated with greater postpartum weight retention, yet long-term implications remain unknown. We aimed to assess whether gestational weight change was associated with mortality more than 50 years later. The Collaborative Perinatal Project (CPP) was a prospective US pregnancy cohort (1959–65). The CPP Mortality Linkage Study linked CPP participants to the National Death Index and Social Security Death Master File for vital status to 2016. Adjusted hazard ratios (HRs) with 95% CIs estimated associations between gestational weight gain and loss according to the 2009 National Academy of Medicine recommendations and mortality by pre-pregnancy BMI. The primary endpoint was all-cause mortality. Secondary endpoints included cardiovascular and diabetes underlying causes of mortality. Among 46 042 participants, 20 839 (45·3%) self-identified as Black and 21 287 (46·2%) as White. Median follow-up time was 52 years (IQR 45–54) and 17 901 (38·9%) participants died. For those who were underweight before pregnancy (BMI <18·5 kg/m; 3809 [9·4%] of 40 689 before imputation for missing data]), weight change above recommendations was associated with increased cardiovascular mortality (HR 1·84 [95% CI 1·08–3·12]) but not all-cause mortality (1·14 [0·86–1·51]) or diabetes-related mortality (0·90 [0·13–6·35]). For those with a normal pre-pregnancy weight (BMI 18·5–24·9 kg/m; 27 921 [68·6%]), weight change above recommendations was associated with increased all-cause (HR 1·09 [1·01–1·18]) and cardiovascular (1·20 [1·04–1·37]) mortality, but not diabetes-related mortality (0·95 [0·61–1·47]). For those who were overweight pre-pregnancy (BMI 25·0–29·9 kg/m; 6251 [15·4%]), weight change above recommendations was associated with elevated all-cause (1·12 [1·01–1·24]) and diabetes-related (1·77 [1·23–2·54]) mortality, but not cardiovascular (1·12 [0·94–1·33]) mortality. For those with pre-pregnancy obesity (≥30·0 kg/m; 2708 [6·7%]), all associations between gestational weight change and mortality had wide CIs and no meaningful relationships could be drawn. Weight change below recommended levels was associated only with a reduced diabetes-related mortality (0·62 [0·48–0·79]) in people with normal pre-pregnancy weight. This study's novel findings support the importance of achieving healthy gestational weight gain within recommendations, adding that the implications might extend beyond the pregnancy window to long-term health, including cardiovascular and diabetes-related mortality. National Institutes of Health.

中文翻译：

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50 年来不同妊娠队列的妊娠体重变化和死亡率：一项前瞻性观察队列研究

怀孕期间体重增加较多与产后体重保持较多有关，但长期影响仍不清楚。我们的目的是评估妊娠期体重变化是否与 50 多年后的死亡率相关。围产期合作项目 (CPP) 是一个前瞻性的美国妊娠队列 (1959-65)。CPP 死亡率关联研究将 CPP 参与者与国家死亡指数和社会保障死亡主档案联系起来，了解 2016 年的生命状况。根据 2009 年美国国家科学院的数据，调整后的风险比 (HR) 为 95% CI，估计妊娠期体重增加和减少之间的关联。按孕前 BMI 的药物建议和死亡率。主要终点是全因死亡率。次要终点包括心血管和糖尿病等死亡原因。在 46 042 名参与者中，20 839 人 (45·3%) 自认为是黑人，21 287 人 (46·2%) 自认为是白人。中位随访时间为 52 年 (IQR 45–54)，17 901 名 (38·9%) 参与者死亡。对于孕前体重过轻的患者（BMI <18·5 kg/m；缺失数据插补前 40 689 中的 3809 [9·4%]]），体重变化高于建议值与心血管死亡率增加相关（HR 1·84） [95% CI 1·08–3·12]），但不是全因死亡率（1·14 [0·86–1·51]）或糖尿病相关死亡率（0·90 [0·13–6·35]） ]）。对于孕前体重正常的女性（BMI 18·5–24·9 kg/m；27 921 [68·6%]），体重变化高于建议值与全因体重增加相关（HR 1·09 [1 ·01–1·18]）和心血管死亡率（1·20 [1·04–1·37]），但不是糖尿病相关死亡率（0·95 [0·61–1·47]）。对于孕前超重的人（BMI 25·0–29·9 kg/m；6251 [15·4%]），体重变化高于建议值与全因体重升高相关（1·12 [1·01– 1·24]）和糖尿病相关（1·77 [1·23–2·54]）死亡率，但不是心血管（1·12 [0·94–1·33]）死亡率。对于孕前肥胖者（≥30·0 kg/m；2708 [6·7%]），妊娠体重变化与死亡率之间的所有关联均具有广泛的置信区间，无法得出有意义的关系。对于孕前体重正常的人群，体重变化低于推荐水平仅与糖尿病相关死亡率降低相关（0·62 [0·48–0·79]）。这项研究的新发现支持了在建议范围内实现健康妊娠期体重增加的重要性，并补充说其影响可能会超出怀孕窗口，影响到长期健康，包括心血管和糖尿病相关的死亡率。美国国立卫生研究院。