Am J Epidemiol. 2023 Aug 4;192(8):1326-1334. doi: 10.1093/aje/kwad075.
Knowledge on the association between offspring birth weight and long-term risk of maternal cardiovascular disease (CVD) mortality is often based on firstborn infants without consideration of women's consecutive births. We studied long-term CVD mortality according to offspring birth weight patterns among women with spontaneous and iatrogenic term deliveries in Norway (1967-2020). We constructed birth weight quartiles (Qs) by combining standardized birth weight with gestational age in quartiles (Q1, Q2/Q3, and Q4) for the women's first 2 births. Mortality was estimated using Cox regression and expressed as hazard ratios (HRs) with 95% confidence intervals (CIs). Changes in offspring birth weight quartiles were associated with long-term maternal CVD mortality. Compared with women who had 2 term infants in Q2/Q3, women with a first offspring in Q2/Q3 and a second in Q1 had higher mortality risk (HR = 1.33, 95% CI: 1.18, 1.50), while risk was lower if the second offspring was in Q4 (HR = 0.78, 95% CI: 0.67, 0.91). The risk increase associated with having a first infant in Q1 was eliminated if the second offspring was in Q4 (HR = 0.99, 95% CI: 0.75, 1.31). These patterns were similar for women with iatrogenic and spontaneous deliveries. Inclusion of information from subsequent births revealed heterogeneity in maternal CVD mortality which was not captured when using only information based on the first offspring.
关于子女出生体重与母亲心血管疾病（CVD）死亡长期风险之间关联的知识，通常基于未经考虑女性连续分娩的初产婴儿。我们研究了挪威自发性和医源性足月分娩女性根据子女出生体重模式的长期 CVD 死亡率（1967-2020 年）。我们通过将标准化出生体重与四分位（Q1、Q2/Q3 和 Q4）中的胎龄相结合，为女性的前两次分娩构建了出生体重四分位数（Qs）。使用 Cox 回归估计死亡率，并以危险比（HR）和 95%置信区间（CI）表示。出生体重四分位的变化与长期母亲 CVD 死亡率相关。与 Q2/Q3 中有 2 个足月婴儿的女性相比，Q2/Q3 中有第一胎和 Q1 中有第二胎的女性死亡风险更高（HR=1.33，95%CI：1.18，1.50），而第二胎在 Q4 的女性风险较低（HR=0.78，95%CI：0.67，0.91）。如果第二胎在 Q4，则与第一胎在 Q1 相关的风险增加被消除（HR=0.99，95%CI：0.75，1.31）。对于医源性和自发性分娩的女性，这些模式相似。纳入随后分娩的信息揭示了母亲 CVD 死亡率的异质性，仅使用基于第一胎的信息时无法捕捉到这种异质性。
