Pregnancy complications increase risk of death for decades

Complications from pregnancy and childbirth have led to high death rates among people who have given birth in the United States, and these complications can have deadly implications as long as 50 years later, according to a new study published in the journal Circulation.

In the United States, more than 800 people die every year giving birth. The latest numbers show that, out of every 100,000 births, more than 23 result in the death of the person delivering. These figures account for deaths in childbirth and during the immediate postpartum period, but the long-term effects of complicated childbirths — which can lead to lifelong health conditions such as heart disease, diabetes and more — have often been overlooked.

Stefanie Hinkle, an assistant professor of epidemiology at Penn Medicine, and her co-authors drew on data collected from more than 46,000 people who’d given birth at a dozen United States health centres between 1959 and 1966. The patients were tracked for deaths of any kind until 2016, at which time 39%, roughly 18,000, had died.

The researchers found that a pre-term childbirth (a delivery three weeks or more before the due date) due to spontaneous labour was tied to a 7% increase in risk of death compared to those who delivered a baby full-term. The risk climbed to 23% for those whose water broke before term, 31% for pre-term induced labour, and a whopping 109% for patients who had a pre-term caesarean delivery, all compared to those who hadn’t had these types of deliveries.

When it came to hypertensive disorders of pregnancy (high blood pressure conditions like preeclampsia, which can be life-threatening), the risk of death in subsequent years ranged from 9% for those with high blood pressure tied specifically to their pregnancy to 32% for those who already had high blood pressure before their pregnancy and then developed preeclampsia in their pregnancy. Finally, gestational diabetes or high blood sugar levels in pregnancy increased the risk of death in the following decades by 14%.

As previous research has shown, deaths in childbirth and the immediate postpartum period disproportionately affect Black people. Hinkle and her colleagues specifically attempted to focus on an area of the research that is largely missing: differences in outcomes by race. Overall, the death rate for Black patients was higher than white patients (41% of the Black patients in the sample compared to 37% of white patients). Pre-term delivery — and, thus, the risk of complications — was much more common, comparatively, in Black patients than white patients (20%, compared to 9%).

“These findings demonstrate how crucial it is to people’s long-term health that we invest in preventive care and screenings for people with complicated pregnancies and deliveries,” Hinkle said. She acknowledged however that more research is needed to determine whether her findings point to pregnancy complications being causal in mortality, or “just predictive by revealing an underlying risk”.

“Future work should seek to understand whether intervening earlier in the postpartum period among high-risk patients prevents future disease incidence,” Hinkle said. “Our group is also currently working to identify low-cost interventions to potentially prevent complicated pregnancies and deliveries.”

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