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BACKGROUND Fetal environment has a substantial influence on an individual's health throughout their life course. Animal models of hypertensive disease of pregnancy (HDP) have demonstrated adverse health outcomes among offspring exposed to HDP in utero. While there are numerous descriptions of the neonatal, infant, and pediatric outcomes of human offspring affected by HDP, there are few data in United States populations on later life outcomes, including mortality. OBJECTIVE To assess risk for early mortality among offspring of pregnancies complicated by HDP. STUDY DESIGN This is a retrospective cohort study of offspring born to women with singleton or twin pregnancies between 1947-1967 with birth certificate information in the Utah Population Database. We identified offspring from delivery diagnoses of gestational hypertension, preeclampsia, or eclampsia. Offspring from these pregnancies (exposed) were matched to offspring of pregnancies without HDP (unexposed) by maternal age at delivery, birth year, sex, and multiple gestation. We also identified unexposed siblings of exposed offspring for a separate sibling analysis. Mortality follow-up of all offspring continued through 2016, at which time they would have been 49-69 years old. Adjusted hazard ratios (aHR) for cause-specific mortality comparing exposed to unexposed offspring were estimated using Cox proportional hazard models. RESULTS We compared mortality risks for 4,050 exposed offspring and 6,989 matched unexposed offspring from the general population and 7,496 unexposed siblings. Mortality risks due to metabolic, respiratory, digestive, nervous, and external causes of death did not differ between exposed and unexposed groups. Mortality risks from cardiovascular disease (CVD) were higher in exposed offspring compared to unexposed offspring (aHR 1.57, 95% CI 1.16-2.12). In sex-specific models among the general population, CVD mortality was significantly associated with exposure among males (aHR 1.92, 95% CI 1.27-2.88) but not among females (aHR 0.97, 95% CI 0.81-1.94). An interaction between HDP exposure and birth order on CVD mortality was significant (p=0.047), suggesting that the effect of HDP on CVD mortality increased with higher birth order. Among siblings, the association between HDP exposure and CVD mortality was not significant (aHR 1.39, 95% CI 0.99-1.95), and this was also true for sex-specific analyses of males (aHR 1.26, 95% CI 0.81-1.94) and females (aHR 1.71, 95% CI 0.96-3.04). As in the general population, there was a significant interaction between HDP exposure and birth order on CVD mortality (p=0.011). CONCLUSION In a United States population, overall mortality risks are higher for offspring of pregnancies complicated by HDP compared to unexposed offspring. Among siblings, there was not a significant association between HDP exposure and CVD mortality.