Objective To assess the association between blood pressure values at 6 weeks postpartum and subsequent cardiovascular disease (CVD) over a 20-year period among women with hypertensive disorders of pregnancy (HDP). Design Population-based cohort study. Setting English primary and secondary care data, linked to cause-specific mortality records from 2000 to 2020. Population A cohort of 39 934 women between 15 and 49 years of age at birth who had HDP, were registered with a general practitioner (GP) contributing to the Clinical Practice Research Datalink (CPRD), and eligible for linkage to hospital episode statistics (HES) data were included. We excluded 22 100 (55.3%) women with no blood pressure values recorded at 6 weeks postpartum. Methods Primary analysis included multivariable Cox regression modelling (weighted by the inverse probability of having a severe HDP). Main Outcome Measure Validated composite outcome of 12 cardiovascular diseases. Results The rate for incident cardiovascular events was 109 per 10 000 person-years; 794 (68%) of them occurred in women aged < 40 years. Women with abnormal blood pressure at 6 weeks postpartum had a higher risk of subsequent CVD than women with normal blood pressure: 10.9% vs. 5.4% - adjusted hazard ratio 1.96 (95% CI 1.51-2.54). Conclusions Less than half of women with HDP had a blood pressure record in their GP notes at 6 weeks postpartum. The absence of a record of normal blood pressure at this time point was associated with an increased risk for subsequent CVD The immediate postpartum period may be a crucial window in preventive care to improve women's health.
Abstract Recent research has documented a higher miscarriage risk among sexual minority individuals than heterosexual individuals. These disparities may be partly mediated by age at pregnancy, gravidity, and use of medically assisted reproduction (MAR). We used data from four cohorts (Nurses’ Health Study 2 and 3, Growing Up Today Study, and National Longitudinal Study of Adolescent to Adult Health) to estimate randomized interventional analogues of mediational direct and indirect effects of sexual orientation on miscarriage (pure natural direct effects [rPNDE], total natural indirect effects [rTNIE], and proportions mediated [rPM]). We found that pregnancies to sexual minority individuals were more likely to end in a miscarriage than those to heterosexual individuals. We found weak mediation of this effect by age (rPNDE: 1.23, 95% confidence interval [CI]: 1.15–1.32; rTNIE: 1.02, 95% CI: 1.01–1.03; rPM: 12%, 95% CI: 5%–19%), but not gravidity (rPM: 2%, 95% CI: -1%–6%) and MAR use (rPM: -1%, 95% CI: -4%–3%). While these factors impact miscarriage risk, our findings suggest that sexual orientation disparities in miscarriage are only minimally explained by age, and not explained by gravidity and use of MAR, contributing to the understanding of the role of pregnancy-related factors vs. structural factors in sexual orientation disparities in miscarriage.
Abstract Studies using routinely collected healthcare data are essential for understanding the benefit–risk profile of medications in pregnancy. However, reproducibility is limited by the lack of shared pregnancy identification algorithms, and generalizability is constrained by their development primarily in commercial insurance databases. A previously developed pregnancy identification algorithm was updated for ICD-10-CM and translated into a standardized format to support transport across diverse databases. Algorithm implementation characteristics were evaluated in three US health insurance claims databases (2000-2025), including commercially and publicly insured populations. Overall, 5.8 million and 3.0 million pregnancies were identified in two commercial databases (Merative™ and Optum) and 2.3 million pregnancies in Merative™ MarketScan® Multi-State Medicaid Database (MDCD). Across databases, live birth prevalence ranged from 76–83%, miscarriage/abortion 15–23%, ectopic pregnancy 1%, and stillbirth ≤0.5%, with a higher proportion of live births in MDCD. Pregnancy dating methods varied substantially across coding eras: use of gestational age records increased from 4-9% in the ICD-9-CM era to 87–92% during the ICD-10-CM era, with greater use in MDCD. Using a standardized algorithm, this study demonstrates how database characteristics and coding transitions influence pregnancy identification and dating in healthcare data, highlighting methodological considerations for reproducible pregnancy research across data sources.
Abstract Stillbirth (fetal death ≥ 20 weeks gestation) occurs in approximately 21,000 births each year in the United States. Previous studies have observed associations between neighborhood deprivation and adverse perinatal outcomes. We estimated associations between neighborhood deprivation and singleton stillbirth in New York. We performed a cross-sectional study of stillbirths and live births from hospital claims data from the Statewide Planning and Research Cooperative System (2022-2024). Neighborhood deprivation index (NDI) at the census tract level was assigned to geocoded addresses at delivery. Risk ratios (RR) and 95% confidence intervals (CIs) were estimated using a generalized estimating equations model adjusted for individual-level maternal variables of age at delivery, race/ethnicity, marital status, and primary health insurance payer. Our analysis included 3,128 stillbirths and 552,361 live births. The NDI quartiles were associated with stillbirth, with higher levels of deprivation corresponding to increased risk compared to the least deprived quartiles. We observed the highest risk of stillbirth among women in the most deprived quartile (RR 1.42; 95% CI 1.25-1.61). The association of NDI quartile on the risk of stillbirth did not differ by race/ethnicity. Our findings highlight that women residing in the most deprived NDI quartile could benefit from enhanced prenatal services and support.
