Introduction One in five women in the United Kingdom is obese at antenatal booking. We aimed to determine whether maternal obesity during pregnancy is associated with increased mortality from cardiovascular events in later life.
Methods Maternity records of women who gave birth to their first child between 1950 and 1976 (n = 18,912) from the Aberdeen Maternity and Neonatal databank were linked to the General Register of Deaths, Scotland and the Scottish Morbidity Record systems. Death and hospital admissions for cardiovascular events up to 1 January 2012 were recorded with median follow-up of 50 years. Maternal body mass index (BMI) was calculated from height and weight measured at the first antenatal visit. The effect of maternal obesity on outcomes was tested with time to event analysis with Cox proportional hazard regression to compare outcomes of mothers in underweight, overweight, or obese categories of BMI as recommended by WHO compared to mothers with normal BMI.
Results All-cause mortality was increased in obese mothers (BMI >30kg/m2) compared with mothers with normal BMI after adjustment for maternal age at delivery, socioeconomic status, smoking status, gestational age at BMI measurement, pre-eclampsia and low birth weight (hazard ratio 1.35, 95% CI: 1.02–1.78). In adjusted models, overweight and obese mothers have increased risk of major cardiovascular events, MACE (1.12, 1.01–1.24 and 1.37, 1.07–1.75 respectively) and hospital admission for a cardiovascular event (1.27, 1.16–1.39 and 1.49, 1.19–1.86) compared to mothers with normal BMI. Underweight mothers also had increased risk of MACE (1.21, 1.00–1.45), suggesting a possible J-shaped relationship.
Conclusions Maternal obesity is associated with an increased risk of premature death and cardiovascular disease in later life. Pregnancy is a key time when women receive input from health care professionals and are motivated to improve their health. This period could represent a window of opportunity for interventions to reduce obesity.
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