71: Causes and timing of death in offspring of pregnancies complicated by hypertensive disease of pregnancy

Abstract

To assess the causes and mortality risks in offspring of pregnancies complicated by hypertensive disease of pregnancy (HDP). In this retrospective cohort study, offspring of women with one or more singleton pregnancies born between (1947-1996) with birth certificate information in the Utah Population Database, were identified with a diagnosis of gestational hypertension, preeclampsia, HELLP syndrome, or eclampsia. Offspring from these mothers (exposed) were matched (1:2) by maternal age at birth, birth year, gender, and multiplicity with offspring of women with no history of HDP (unexposed offspring). Adjusted hazard ratios (aHR) for cause-specific mortality (cardiovascular disease, neoplasm, metabolic, respiratory , digestive, nervous, external causes) among exposed offspring, compared to unexposed offspring (matched unexposed individuals from the population), as well as unexposed siblings, were estimated using Cox proportional hazard models. We also restricted the analysis to offspring born between 1947-1967 (now aged 40-60) as they had a higher incidence of death. A total of 24,980 exposed offspring were matched to 44,091 unexposed offspring and to 44,455 unexposed siblings. For offspring born through 1996, 4.4% exposed, 3.6% unexposed offspring and 4.5% unexposed siblings had died. When restricting analyses to offspring born between 1947-1967, 14.0% exposed, 11.1% unexposed offspring and 11.6% siblings had died (Figure 1). Mortality from metabolic, respiratory , digestive, nervous and external causes were not different in the compared groups. Mortality from cardiovascular disease (CVD) was significantly higher in exposed vs. unexposed offspring (aHR 1.51, 95%CI 1.11-2.06), and vs. their siblings (aHR 1.41, 95% CI 1.01-1.96). For sex-specific models, CVD remained the most significant cause of death for exposed vs. unexposed males (aHR 1.88, 95%CI 1.25-2.83) but not among females (1.04, 95%CI 0.62-1.74) in the general population. Among same sex sibling pair, females have a significantly higher risk of CVD cause of death (1.82, 95%CI 1.02-3.25) but not the males siblings (aHR 1.22, 95%CI 0.79-1.87) (Figure 2). Offspring of pregnancies complicated by HDP have increased mortality risk when compared to unexposed offspring and siblings, particularly for CVD mortality followed by neoplasms.View Large Image Figure ViewerDownload Hi-res image Download (PPT)